Most of us have visited the local emergency branch for one thing or another. Whether bringing your elderly neighbor to the Er after a fall, or having your child evaluated after a hard hit on the football field, you'll probably visit the local urgent care or emergency branch at least twice in your life. Periodically in the news we hear of renowned persons dying after a head injury. As a corollary of the media hype, my Er along all of the others in the United States see an immediate spike in emergency room visits for minor head trauma from fearful patients. That's ok with me, as part of my job is to give you peace of mind as well as to tell you that your not going to die from that wee bump on your head.
But when a head injury occurs, when should you go to the Er and what should you expect? How do you know if its genuinely a "serious" head injury? everyone knows that Ers are high-priced and crowded, and sometimes the wait to be seen can be 4-6 hours. No one wants to waste time and money, but if your child falls and bangs his head on the coffee table, and you see a growing purple lump on his head, what else are you going to do? Does he need to go to the Er for a X-rays or Cat Scan? Here are some points to think when deciding Whether you need to rush to the Er or not.
Is there a laceration? If there is any wound on the face, you should go. This goes for lacerations as well as periorbital trauma (trauma to the eye sockets) and nasal or oral trauma. Scalp lacerations smaller than 3mm can usually be managed at home if there isn't essential bleeding.
What was the mechanism of injury? The vast majority of head injuries come from falls where the head strikes the ground, table or some other inanimate object. Don't let this changeable dictate Whether you go to the Er or not. The height of the fall, or speed of object astonishing a person, is not a reliable indicator of inherent basic injury. When in doubt, go see a doctor.
Is there a concussion or brain injury? This is the million dollar ask and the real purpose behind this article. While lacerations and moderate facial trauma may work on some cosmetic and functional outcome, a true brain injury or brain bleed, can cause death or a essential life long disability. So how can you tell if this is occurring? Let's begin with a simple definition of a concussion. A concussion is simply an injury that occurs to the brain from a blow to the head. The brain genuinely gets rattled colse to in the skull and can cause bruising of the brain, or worse, axonal shearing which can be concept of as your nerves genuinely being torn in half. Symptoms of concussion can range from mild dizziness and sick to severe vertigo and vomiting with confusion and inability to walk or remember events. Whether way, in most cases is a concussion is a condition in which the inpatient fully recovers with wee or no chronic effects. The tricky part in declaring that person has a concussion lies in the fact that there is no test for most mild to moderate concussions. No black and white labs or imaging that will tell you a person is concussed. It is strictly a clinical judgement by finding at the symptoms, and if the symptoms are severe enough, you must think and study the possibility of a more head serious injury.
A brain bleed on the other hand is an immediate medical emergency. Blood streams into the cranium putting pressure on the brain. The brain is then genuinely forced down into the foramen magnum, the hole where your spinal cord exits the skull. The corollary is that the cerebellum, the area of your brain responsible for spontaneous respiration and cardiac function, genuinely gets smashed through the foramen magnum, killing the patient. As expected, a inpatient with a brain bleed first experiences a severe sick and vomiting, then stiffness of the neck and other neurological symptoms similar to stroke, and ultimately death. If the inpatient doesn't have any essential symptoms after the first few "golden hours", chances are best that they have a simple concussion and not a bleed.
Do I need a Cat Scan? A lump on the scalp is like a bruise that swells underneath the scalp, but above the skullbones. It doesn't mean there is bleeding inside the cranium. But since bleeding inside the brain case can be so serious, we often fetch a computerized set of x-rays call a Ct Scan. The medical appropriate of care for Ct scans in head injuries is basically this: If the inpatient was knocked unconscious or there is a suspicion of an intracranial bleed or fracture, a Ct scan is necessary. So you can see there is some wiggle room for the personal judgment of the medical provider. Keep in mind though, studies show that while a single head Ct exam, a person's brain is exposed to the equivalent of up to 300 Xrays! When I order an Ct of the brain and skull, I have high suspicion of true injury (or high suspicion of liability I'm sorry to say!). With that in mind, if the inpatient doesn't have brain bleed symptoms, a Ct scan is not warranted as the exposure to high doses of radiation increases the chances of cancer and other complications.
So what's the bottom line? How do you know if you need to go to the Er? Look at the entire situation and make your decision. Basically, if there is nothing to fix like a laceration or broken bone, and the inpatient denies having a essential headache, and is walking and talking as usual, they probably don't have an intracranial bleed. If you're not sure however, go see the doctor! It's a judgement call on your part and no one will blame you for erring on the side of caution. You can never be too meticulous and as I said before, my role as a trauma Pa is not only to treat patients and prescribe medicines, but also to set your mind at ease that your going to be ok.
Lung Cancer Definition:Head Injury and Concussion - How to Tell If It's Serious and When to Go to the Er!
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