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How to Treat a Concussion - Carte Blanche

News
03 February 2019
Concussions are often tricky to diagnose since no visible injury, such as an open wound or bump on the head, has to be present.
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A concussion: it’s one of the most common brain injuries which could affect anyone at any point in their life - whether you sustain a concussion following a car accident, a fall while doing simple house chores or during a brutal rugby match.

 

What Causes A Concussion?

Concussions are usually caused by a strong bump or blow to the head, or a sudden jolt of the head. However, it could also be caused by a sudden jolt to the body where the head is jerked backwards, forwards or to the side. The abrupt movement of the head causes the brain to bounce or shake and, depending on the impact, even twist and turn, inside the skull. The motion of the brain leads to damage of brain cells while also changing the chemical balances within the brain.

Most children get concussed while playing, riding a bike or playing contact sports, while adults are more likely to sustain concussions in car accidents, falls, physical assaults and objects falling on their heads.

Concussions are often tricky to diagnose since no visible injury, such as an open wound or bump on the head, has to be present. While a severe concussion usually presents symptoms immediately, it could take several days before a mild concussion begins to show signs of injury. It’s for this reason that it’s vital to seek immediate medical attention the moment any form of head injury occurs. Just because you don’t feel dizzy or pass out immediately after a hit to the head, doesn’t mean you don’t have a concussion. Rather err on the side of caution.

 

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The Signs

Following an injury, patients would often report one or all of the below:

  • Seeing stars or lights in front of the eyes
  • Blurred or double vision
  • Ringing in the ears
  • Enlarged pupils
  • Slurred speech
  • General confusion
  • The urge to close their eyes

 

What Are The Symptoms?

The symptoms of a concussion caused by a head injury are often varied and could last anything from a few hours to several months. In most cases, a headache begins to develop immediately. Seek urgent medical assistance if the headache worsens within the next 24 hours as this could indicate possible bleeding within the skull.

Other symptoms include:

  • Nausea
  • Dizziness
  • Difficulty with balance
  • Light and noise sensitivity
  • Drowsiness and constant fatigue
  • Sudden changes in sleep patterns
  • Difficulty concentrating or putting together sentences
  • Sudden depression or unexplained sadness
  • Irritability
  • Unexplained nervousness or anxiety
  • Confusion or a sense of brain fog

Should any of the below symptoms appear, seek medical assistance immediately.

  • Seizures
  • Unconsciousness (even just briefly)
  • Suddenly unable to identify people, places or objects
  • Unusual behaviour

In the case of small children, the following could also be cause for concern:

  • Constant crying
  • Extreme agitation and inability to calm down
  • Doesn’t want to nurse or eat

 

What To Do

Immediately after an injury is sustained, it’s important to keep the person’s head as still as possible until medical assistance arrives. Do not move the person unless it is absolutely necessary. You can also do any of the following:

  • If the person is conscious, ask them simple questions such as their name, what day it is, their age, how many fingers you’re holding up or what year it is to determine how coherent they are. You can also ask the person to repeat simple sentences to determine their cognitive ability.
  • Hold up a finger and ask the person to follow it with his/her eyes.
  • Pinch the person’s hand or arm gently to check whether the person registers the sensation.
  • Keep talking to the person to prevent them from passing out.
  • Apply ice to the swollen area on the head, or pressure if it’s an open wound.

If the person is unconscious, DO NOT tilt their head backwards. However, if the person isn’t breathing, ask someone else to stabilise the person’s head before administering CPR. If the person is choking, you can very carefully turn the person on his/her side while fully supporting the head as well as the spine (try and keep the spine as straight as possible, as a spinal injury is also possible).

 

The Next 24 Hours

Following proper assessment by a medical expert, the person must not be left alone for the next 24 hours.

  • Keep a close eye on their cognitive and physical state and contact emergency services the moment you notice any changes.
  • The person is allowed to sleep, but wake them up every 15 minutes for the first 2 hours. Thereafter, every 30 minutes. Finally, you can wake them once every hour. Each time you wake the person you should perform what is called the Alert, Verbal, Pain, Unresponsive (AVPU) test:
    • Alert: Check how alert the person is. Is he/she fully awake and responding normally to requests to make certain movements or gestures.
    • Verbal: Does the person respond to verbal cues. While the person doesn’t necessarily have to say anything, they must show that they at least recognise the question through either nodding or simple sounds.
    • Pain: Apply light pressure to extremities and ask the person to respond when they feel pain.
    • Unresponsive: if the person doesn’t seem to respond to any of the above, or is unconscious, you must seek medical assistance immediately.

 

The Recovery Process

Recovering from a concussion could take weeks to months, depending on the extent of the injury. It’s important that the patient rests and avoids any activities such as the below for the next two weeks:

  • Watching television
  • Extended periods of reading
  • Using a computer, cellphone or tablet
  • Video gaming
  • Texting for long periods
  • Listening to music with headphones
  • Prolonged periods of homework
  • Driving

 

Helpful Resources

For more information on how to prevent, identify and treat concussions within a sports setting, Boksmart and Sports Concussion South Africa have several guidelines while also offering workshops and assistance to coaches, parents and players. 

Sources: Mayo Clinic | Boksmart | Sports Concussion South Africa