Concussions - Dr. S. Fling

• Definition: Trauma-induced alteration in mental status with or without loss of consciousness
• Concussions occur as a result of neurometabolic destruction at the cellular rather than structural level, which is why our current modalities of imaging are negative.
• Concussive symptoms are divided into 4 categories: Cognitive, physical, emotional, sleep-related
• Patients who are at increased risk of prolonged concussive symptoms include those with severe initial symptoms, teenagers, females, and those with previous concussions
• Beware secondary impact syndrome which occurs when a patient re-injures their brain before full recovery from previous injury
• As far as ED management, history is key along with a thorough physical exam including a neuro exam. Do not forget to check for gait instability, which is the most specific indicator of concussion
• From your neuro exam, use PECARN to determine if a CT scan is indicated to determine structural injury
• Discharge instructions are key. The Big 5 include:

1. Cognitive rest first 24-48 hours after injury
2. More benefit in uninterrupted sleep
3. Graded return to sport protocol
4. Symptom free without meds before full return to play
5. Set Expectations
   

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