Emergent Care for TBI: Starts at Moment of Impact

Concussion is a traumatic brain injury, not to be taken lightly. And evaluation to determine whether a concussion has occurred should begin shortly after the moment of impact, says Dr. Korin Hudson, MD, Department of Emergency Medicine, Georgetown School of Medicine.

Dr. Hudson uses the following example: “Suppose a kid playing basketball slips, falls and hits their head on the ground during a basketball game. Their head bounces off the basketball court and they seem stunned for a minute. The question arises: do they have a concussion? Is it serious enough that they need to be rushed to the ER right now for a physician’s evaluation?”

The awareness that this could be a medical emergency represents “a great evolution in the recognition of concussion as an injury,” says Dr. Hudson.

If the young basketball player falls and comes up holding their head, or if they’re looking a little confused and blinking, they need to come out of the game. Immediately. As far as emergent care, step one is pulling them out of the game and deciding they’re done for the day. Step two is the assessment of whether they need to head to the emergency department or their primary care doctor, based on what are called Red Flag Symptoms. These can be found on the CDC website, https://www.cdc.gov/headsup/basics/concussion_danger_signs.html.

Based on the medical assessment, the student may arrive at the ER and, if indicated, a full neurologic exam would be performed. “Depending on the results of assessing for red flag symptoms, the emergency room physicians is determining whether this is a concussion or is it something else?” explains Dr. Hudson.

“When I think of the “is this something else,” I’m wondering about bleeding or bruising or swelling in the brain. By definition, a concussion is a transient issue in the brain that does not involve one of those things. There’s no structural damage to the brain. But when we see those red flag symptoms, we’re worried that there might be bleeding or bruising or swelling, and those things may require intervention. They might need medications, they might even need surgery,” says Dr. Hudson. It all starts, she says, with evaluation as soon as possible following the actual moment of impact.