Treat a Concussion

When a blow to the head shakes the brain within the space between the brain and the skull, the resulting shaking is known as concussion. A concussion is the most common type of head injury. While most concussion is a temporary disturbance that doesn't leave lasting damage, it can lead to associated serious problems if not treated promptly and effectively.

The potential for concussion is so high, and the causes so common and varied, that it makes good sense to know what to do to administer first aid to a concussion victim. It is an especially useful skill if you play a sport, practice wilderness activities, or have children in your care.

Steps

 * 1) Assess the victim. Examine the wound and look carefully at the victim. Visible external injuries are not always a good gauge, as some very minor scalp wounds bleed profusely, while some less visible impact injuries can cause major brain impairment. If the victim displays two or more of the following symptoms, assume that this is a case of concussion and treat the victim appropriately:
 * 2) *Physical symptoms include:
 * 3) **Loss of consciousness during the injury (steps for assessing consciousness are provided below).
 * 4) **Severe headache.
 * 5) **Light sensitivity.
 * 6) **Double or blurred vision.
 * 7) **Seeing "stars", spots or other visual anomalies.
 * 8) **Loss of coordination and balance.
 * 9) **Vertigo.
 * 10) **Numbness, tingling, or weakness in legs and arms.
 * 11) **Stumbling or poor hand-eye coordination.
 * 12) **Nausea and vomiting.
 * 13) *Emotional symptoms include:
 * 14) **Unusual irritability or excitability.
 * 15) **Disinterest.
 * 16) **Difficulties with concentration, logic, and memory.
 * 17) **Mood swings or outbursts of inappropriate emotions.
 * 18) **Tearfulness.
 * 19) **Sleepiness or lethargy.
 * 20) *For distinguishing generally between the differing types of head injury, you can read more details in wikiHow's article on identifying head injury symptoms.
 * 21) Any suspected head injury, or concussion, needs to be evaluated by a medical professional. What may seem like a minor head injury could be a fatal one. The best rule is to call for medical assistance if you have any doubts, and especially:
 * 22) *where there is any change in the level of consciousness, or whenever unconsciousness is involved,
 * 23) *where you are unsure as to the state of the victim, and feel that it is impossible to judge the "severity" or otherwise of the concussion,
 * 24) *where the victim has been in a serious accident such as a road crash or has been impacted severely, and
 * 25) *where the victim complains that the symptoms are worsening. Even where the victim is thought to have recovered enough to go home, the victim should be advised to seek medical attention immediately if he or she experiences headaches, nausea, vomiting, or excessive sleepiness.
 * 26) *If you notice:
 * 27) **Weakness on one side of the body.
 * 28) **Pupils that do not react equally to light (one stays more dilated than the other).
 * 29) **Slurred speech.
 * 30) **Dragging one foot when attempting to walk or other uncoordinated movements.
 * 31) **Drooping on one corner of the mouth or one eyelid.
 * 32) **For any of the above, do not wait, call for emergency medical treatment immediately.
 * 33) Keep the victim as still as possible. Avoid moving the victim, as doing so may cause further injury. However, in the case of a car wreck or other severe accident, it may be necessary to move the victim.
 * 34) *When calling for help from a cell phone or radio, remain with the victim. Alternately, ask a helper to call for assistance while you stay with the victim.
 * 35) *Make sure not to let the victim walk away if you suspect a concussion, as symptoms may not be apparent immediately and stay with the victim at all times.
 * 36) Know how to assess consciousness. It is important to know whether or not the victim is conscious, as the victim needs special positioning if unconscious, paying particular attention to breathing. To check the consciousness of the victim, try the AVPU code:
 * 37) *A - is the victim alert? - are your questions being answered? (see step below for question samples)
 * 38) *V - does the victim respond to voice? - give spoken commands or ask questions (see step below for question samples)
 * 39) *P - does the victim respond to pain or touch? - pinch skin to see if there is movement or eyes opening
 * 40) *U - is the victim unresponsive to anything attempted?
 * 41) If the victim is unconscious, or falls unconscious, position the victim on their side, in the "recovery" position, with the head slightly raised. Clear the airway if necessary and check breathing and circulation. You must seek immediate medical help if the victim is, or falls, unconscious.
 * 42) If the victim is conscious, ask questions continually. This serves two purposes: to assess the degree of the victim's impairment, and to keep the victim awake. Good questions include:
 * 43) *"What is today's date?"
 * 44) *"What happened to you?"
 * 45) *"What is your name?"
 * 46) *"Are you feeling (insert symptom)?"
 * 47) Keep the conscious or unconscious victim's head cool with an ice pack or damp cloths. This can prevent brain swelling. Monitor the body temperature, however, as the victim should be protected from any extremes of temperature.
 * 48) Allow the victim to rest. If you have to wait a long time for medical help to arrive (for example, if you're in back country), the victim should be placed in the recovery position. If the victim wishes to sleep, wake the victim every quarter hour for the first 2 hours, then every half hour for the following 2 hours, then hourly. Every time you wake them, do the AVPU consciousness test as outlined above. It may be irritating for the victim and tiring for you, but their safety is your number one priority. If the victim does not respond to being woken up, treat as for an unconscious patient.

Tips

 * Note that it is not possible for a first aider to treat head injuries; this can only be done by medical specialists. Your role is to create the best possible conditions of care until medical help arrives. If you suspect the injury is worse than concussion (for instance, if you see the pupils dilating), the care remains the same - keeping the patient comfortable and quiet, remaining with them, dressing any obvious wounds with clean bandaging, and continuously checking the victim's airway.
 * It is a good idea to conduct a secondary survey for any other conditions, such as a wound to the scalp after you have made the initial assessment for concussion.
 * Basic pain relief is permissible (for example Tylenol) but do not use anti-inflammatory drugs or aspirin in case there is internal bleeding. Remember also that pain relief can mask other symptoms that may need treatment.
 * You can also ice the head with a good degree of confidence. This can not only provide some pain relief, but it can contain and prevent further swelling until help arrives (or until s/he feels better, depending on the severity of the bump). Just get a baggie and fill it with ice. If you have a towel or t-shirt, wrap the bag of ice in that and apply it to the area of the bump.
 * ask simple questions

Warnings

 * Treat all head injuries seriously, especially if the impact to the head involves infants and young children who are less able to explain what is happening to them. In any case where the victim complains of symptoms such as severe headaches, blurred vision, excessive sleepiness, or lack of coordination, get them to professional medical assistance as soon as possible. It is a good idea to have someone remain with a concussion victim through the night to ensure that help can be given if needed suddenly.
 * Never let a concussed person out of your sight until medical attention arrives. If the injury occurred as the result of a sports match, do not allow the victim to return to playing.

Things You'll Need

 * Suitable place to tend to victim - if you are near a roadside, try to move the victim with care away from traffic
 * Basic First Aid knowledge
 * Clean bandaging (if relevant)
 * Cell phone or radio

Related Tips and Steps

 * How to Recognize TBI Symptoms (Traumatic Brain Injury)
 * How to Manage Recovery from a TBI (Traumatic Brain Injury)
 * How to Recognize TBI Symptoms in Children (Traumatic Brain Injury)
 * How to Treat Shock
 * How to Stop Bleeding

Sources and Citations

 * Wikipedia on Concussion: http://en.wikipedia.org/wiki/Concussion