We hear a lot about concussions related to organized sports, particularly during football season and the school year. But did you know that concussions are top of mind for emergency medicine professionals at other times, too?
“Our experience tells us that people still don’t use helmets often enough, even when they know about the potential for serious injury,” said Frank Szatkowski, MD, an emergency medicine physician at ProHealth Care. “Young people in particular often feel that they are invincible and an injury won’t happen to them. A traumatic brain injury can affect a person of any age – and for life.”
After 15 years of experience in emergency medicine, Dr. Szatkowski has seen it all, and then some. Still, his top health care recommendation is to wear a helmet. He said that helmets should be used for any activity that has the potential for head injury — cycling, skateboarding, water and snow skiing, snow and wake boarding, and also riding motorcycles, ATVs, hoverboards and scooters.
Dr. Szatkowski said any person who has suffered a head injury should consider being seen right away by a physician who has experience managing concussions. Even when there may be no visible bleeding, bumps or bruises, a serious injury may have occurred. After a head injury, watch for loss of consciousness, vomiting, confusion or changes in behavior. If these symptoms are present, the individual needs to be immediately evaluated in an emergency department.
Don’t hesitate to call 911 if someone is experiencing any symptoms of concern, Dr. Szatkowski said. If there is any reason to suspect a back, neck or serious head injury, such as severe pain or the inability to move, call 911. Do not move the injured person or remove the person’s helmet.
“Following a head injury, any kind of neurological deficit in vision, speech, gait or change in behavior requires immediate care,” Dr. Szatkowski emphasized. “Individuals don’t have to lose consciousness to be in danger.”
Signs and symptoms of a head injury may include the person appearing dazed, stunned, confused fatigued, nauseated or visually impaired; speaking slowly or haltingly; repeating questions; and indicating balance or memory issues, numbness, tingling, sensitivity to light or noise, or a change in behavior.
Health concerns after a brain injury are both short term and long term. At the emergency department, a physician will conduct a physical and neurological examination of the patient based on national guidelines for head and other trauma. The emergency department exam also will include questions about medications – especially blood thinners. In fact, Dr. Szatkowski said that anyone who takes a blood thinner should consider an emergency evaluation after any trauma, even if the head is not involved.
Among the emergency physician’s primary concerns are whether there might be a concussion or bleeding in the brain. The medical exam will indicate whether the patient should be further tested for head trauma, which may involve a CT scan or other tests. At that time, treatment will be considered and provided as needed.
“Concussions, brain bleeds and skull fractures can have significant lifelong results,” Dr. Szatkowski said. “When you hit your head it may not seem like a big deal at first. You could have a second or a third injury — and end up having significant neurological problems later in life.”
In the case of a simple concussion, a CT scan is not always necessary, based on the medical examination and national guidelines for emergency care. If the patient goes directly home from the emergency department with a concussion, the emergency physician will provide instructions regarding rest, activities and follow-up health care.
When the physician determines that a CT scan is required, it is typically to look for bleeding or swelling of the brain, or skull fracture after head injury. If this type of injury is found, it typically requires emergency care in a hospital so doctors can closely monitor a patient’s neurological status. With a traumatic brain injury, swelling and pressure on the brain may cause serious disability or death.
“Sensory rest is very important when dealing with a traumatic brain injury,” Dr. Szatkowski said. “You don’t want the patient to be exposed to excessive light, sound or stimulation for a period of time. The brain needs time to rest and heal after an injury. Just like not running on a sprained ankle, you don’t want to over-stimulate your brain until it has recovered.”
Physical rest also is very important. Anything that causes increased blood pressure and heart rate – or causes physical bouncing or jarring of the body – continues to irritate the injured brain. Physical activity must be reduced until all signs of the brain injury have subsided. Re-evaluation by your primary care physician is always recommended before return to full activity or sports.
In some cases, patients who have experienced head injuries are referred for follow-up outpatient evaluation and treatment. At ProHealth Care, a medical team develops a treatment plan that may involve physical, occupational and speech therapy, as well as behavioral medicine to address depression, anxiety or other psychological effects that could possibly result from a brain injury.
Dr. Szatkowski notes that emergency room providers are available at all times, day and night, and are specially trained to evaluate head injuries. Always use the emergency department for evaluation of head injuries – as well as any other condition that could be serious or life- or limb-threatening. Use walk-in clinics or urgent care centers for care of minor summer ailments or less serious injuries that could otherwise be treated in the doctor’s office.
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For more than a century, ProHealth Care has been the health care leader in Waukesha County and surrounding areas, providing outstanding care across a full spectrum of services. The people of ProHealth Care strive to continuously improve the health and well-being of the community by combining skill, compassion and innovation. The ProHealth family includes ProHealth Waukesha Memorial Hospital, ProHealth Oconomowoc Memorial Hospital, ProHealth Rehabilitation Hospital of Wisconsin, ProHealth Medical Group, the UW Cancer Center at ProHealth Care, Moreland Surgery Center, ProHealth AngelsGrace Hospice, ProHealth Home Care, ProHealth West Wood Health & Fitness Center and ProHealth Regency Senior Communities. Learn more at ProHealthCare.org.