Traumatic Brain Injury

Concussion: A concussion is a direct blow to the head or violent movement (like wipe lash) that may cause the brain to bump the inner portion of the skull. The word comes from the Latin "concutere," which means "to shake violently." The brain momentarily doesn't function properly. Usually there is no loss of consciousness or the loss is brief. The Mayo Clinic gives this definition: "A concussion is a traumatic brain injury that alters the way your brain functions. Effects are usually temporary but can include headaches and problems with concentration, memory, balance and coordination."
Symptoms:
  • Brief change in level of responsiveness
  • Short-term amnesia
  • Temporary blurred vision or seeing stars
  • Nausea and/or momentary vomiting
  • Headache
  • Dizziness or lethargy
  • Problems with balance and/or coordination
  Grade 1 Mild: There is no loss of consciousness. but symptoms last for less than 15 minutes.
  Grade 2 Moderate: There is no loss of consciousness but symptoms last for greater than 15 minutes.
  Grade 3 Severe: The person loses consciousness, sometimes just for a few seconds.

Treatment: It is my personal feeling that all concussion patients should seek medical attention. A medical specialist can decide on the degree of severity and appropriate care. One should be monitored over the coming hours. The problem with even a mild concussion is that there is a risk of bleeding in the "subdural space" (between the brain and it's covering) with signs developing over several hours. This can be life threatening. The brain is enclosed in a tight compartment and bleeding can put pressure on the brain resulting in brain damage. A grade 3 should always be considered a medical emergency. Note: In the wilderness, immediate evacuation is required. A patient that quickly awakens with no other symptoms, can be walked out (but should be accompanied by another individual to watch for late onset signs of subdural bleeding).1.


Traumatic Brain Injury: A contusion (bruising) of the brain and/or subdural bleeding. Symptoms of the above are more severe, prolonged and individual may be unconscious.
Symptoms:
  • Increasing prolonged symptoms noted above
  • More severe or prolonged changes in level of responsiveness, i.e., disoriented or remains unconscious
  • Increasing headache, vision disturbances
  • Hyperventilation
  • Combativeness
  • More severe symptoms:
    1. Seizures
    2. Erratic respiration such as Cheyne-Stokes (also video)
    3. Blood or spinal fluid leakage form the nose, ears or wound
    4. Slowing pulse, increased blood pressure
Treatment:
  • Follow the ABC's in approach and assessment.
  • Have someone call 911.
  • Hold neck stabilization (C-spine) assuming possible neck injury.
  • Question bystanders as to loss of responsiveness (immediate or delayed). Has the patient been confused or drowsy.
  • Notes:
    1. If vomiting, perform a spinal roll.
    2. Control scalp bleeding in necessary. Apply light pressure at the edges of the wound so as not to disturb any unstable bone. Use a bulky dressing. Do not clean as one may introduce infection.
    3. Do not control internal bleeding or leakage of clear spinal fluid (to do so may increase intra cranial pressure and damage to the brain).
References:
  1. Wilderness Medicine by Tod Schimelpfenig, Director of the National Outdoor Leadership School, 2008, Stackpole Books, ISBN-13: 978-0-8117-3306-9
  2. Concussion  From the Mayo Clinic
  3. Concussion (Traumatic Brain Injury  From WebMD
  4. What is Traumatic Brain Injury?  From TraumaticBrainInjury.com
  5. NINDS Traumatic Brain Injury Information Page  From the National Institute of Neurologic Disorders and Stroke
  6. Injury Prevention & Control: Traumatic Brain Injury  From the Center for Disease Control



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