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Concussions - Dr. S. Fling

12/7/2017

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Picture
  • 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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  • RESIDENCY
    • About CMC
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • (All Others)
  • PEOPLE
    • Program Leadership
    • PGY-3
    • PGY-2
    • PGY-1
    • Alumni
  • STUDENTS/APPLICANTS
    • Medical Students at CMC
    • EM Acting Internship
    • Healthcare Disparities Externship
    • Resident Mentorship
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction