Concussion tx

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Specializes in LTC.

I figured this was the best place to ask the question. I'm in nursing school and for one of my classes, we have to make up a scenario for our fellow classmates to read and solve, like a case study. I have ideas, but I don't really know what would happen from beginning to end with my patient.

My "patient" slipped on the ice and hit her head, lost consciousness. Her boyfriend brought her to the ER in his car. I want her to be out for the entire car ride and long enough in the ER to be hooked up to an IV (would they do this for a concussion? Since it could be anything, really? And would it just be fluids?). Would she have long-term damage if she was out that long? As long as she was breathing and had a pulse, is that common? For people to be out that long?

I know afterward that they might do neurological exams -- would this follow the q15 mins x4, q30 mins x4, q1h x4, et so on or are they different? Or do they differ everywhere? Are scans mandatory or only in cases where they're symptomatic?

How long are they normally in the hospital? Would it be realistic for her to be discharged the same day as long as she was asymptomatic?

Just in case it needs to be said, this is merely for a school assignment and there will no profit made or anything with this. :)

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dont know about all cases but can speak of mine. hit hard on the head, didnt go to er for 24 hours. was still dizzy. got scanned, basic neuro exam (had had a full one 3 days earlier). discharged same day.

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This is not going to help you with your assignment. It might help you get an "A", but using my and everybody else's posts aren't going to help you get what they're trying to teach. That being said, here you go....

IVF are definitely going to be hooked up. Depending on age, probably 100+ml/hr. Neuro checks are also a must. q15 or so is sufficient for the first hour or two if it's not a severe injury.

Speaking from a Trauma standpoint, two large bore IV 18g or higher are usually placed.

CT of the head to rule out hematoma would be high on the list.

The patient would almost definitely be sent to an ICU if the LOC was 20+ minutes. USUALLY LOC is much less than this. For a LOC that is >20min then you typically may have other side effects (no respirations, etc) that would have not enabled him to drive the patient to the ER... He instead would have had to wait for EMS while doing rescue breathing...

Lasting effects depend on severity of injury. If it's a simple concussion then expecting excessive veritgo and nausea and vomiting is more than likely. Scopalamine patch, Zofran, and Morphine would be probably the basics... If hematoma is present, possible hematoma evacuation, skull plate removal for pressure relief, and/or placement of burholes to check for ICP may be completed. If this is the case, also, the patient will probably be intubated and mildly sedated with something such as propofol - this makes it easier to bring the patient out of sedation to being interactive in

Depending on how the person fell, usually they just don't hit ONE thing, so other body parts may hurt. 2 or 3 view xrays may also be in order to extremities, possibly abdominal and chest to rule out anything else more severe.

The patient may be kept NPO until the AM in case of nausea and/or waiting for a followup CT of the head 24 hours out. If everything is fine, the patient may go home in a day or two.

Finally you may be able to put a scalp lac in there somewhere that needs sutures? Complete with irrigation of the wound and everything else that is involved with this type of injury (lido, etc)

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Specializes in ER, Trauma.

Just a side note. Gallows humor for this kind of patient. Morbidly funny but true.

When alert the patient will have repetitive questioning. Where am I, what happened, how did I get here, and maybe a few others. They usually "reset" themselves and start all over every 30 to 60 seconds. If family is at the bedside they'll go through stages (probably you too). 1st answering the questions, 2nd finding it a bit frustrating and at the same time funny, 3rd ready to strangle the patient if they ask just one more time. It's all normal, predictable, enjoy the fact that you can leave the room, the family can't.

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Specializes in Psych, M/S, Ortho, Float..

2 months after my concussion (mild to moderate, no LOC. I was unable to recall my address, photophobia and unable to walk straight) I was still feeling drepressed and sad because I was still having co-ordination problems and disorientation. It was all gone by the end of the 3rd month, but it made me realize that it is not just in the first couple of days after the head trauma that people feel miserable.

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
It's all normal, predictable, enjoy the fact that you can leave the room, the family can't.

I had a fall-from-horse/head injury patient that "reset" each 30 seconds. After a while, I wrote a note explaining what happened and why the patient was in the ER on a piece of paper, attached it to a clipboard, and placed it in the patient's hands. The patient must have read that note a thousand times, ha ha!! :D

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Specializes in ER, Trauma.

I humbly admit I'm in the presence of true genius.

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Specializes in ER.

Lunah, I'm going to use that idea. Thanks.

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

Please do! I've found it to be helpful, and comforting for the patient when they do that panic thing every few minutes! :)

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