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1.03 Minor Head Trauma ("Concussion")


Presentation

A patient is brought to the ED after suffering a blow to the head. There may or may not be a laceration, scalp hematoma, headache, transient sleepiness and/or nausea, but there was NO loss of consciousness, amnesia for the injury or preceding events, seizure, neurological changes, or disorientation. The patient or family may express concern about a "mild concussion," the possibility of a skull fracture, or a rapidly developing scalp hematoma or "goose egg."

What to do:

What not to do:

Discussion

The risks of late neurological sequelae (subdural hematoma, seizure disorder, meningitis, post concussion syndrome, etc.) make good followup essential after any head trauma; but the vast majority of patients without findings on initial examination do well. It is probably unwise to describe to the patient all of the subtle possible long-term effects of head trauma, because many may be induced by suggestion. Concentrate on making sure all understand the danger signs to watch for over the next few days. A large scalp hematoma may have a soft central area which mimics a depression in the skull when palpated directly, but allows palpation of the underlying skull when pushed to one side. Cold packs may be recommended to reduce the swelling, and the patient may be reassured that the hematoma will resolve over days to weeks. Patients with minor head injuries who meet the criteria for a CT scan but who have a normal scan and neurological examination may be safely discharged from the ED.

References:


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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
Jon Handler, MD
Michael Gillam, MD