Head injuries

great_lakes_expat · Oct 6, 2017

Y'all, I am really appreciating this thread, cause I can never figure out what to do with my "head bump" kids. My district has a form letter that gets sent home, and we are supposed to call each parent. Often, I can't reach anyone and if the kid seems fine I just send the letter and that's that.

But I wanted to share a resource that has been extremely helpful to me- Schmidt's Pediatric Telephone Protocols. It's pricey but GOLD. It was recommended to me by an RN buddy who does peds telephone triage. It breaks down everything into categories according to what the next level of care is (if any). Call 911, Go to ER, Go to PCP now, Go to PCP within 3 days, etc.

For head injury, it says that a mild headache is normal and they don't need to be seen by their doctor unless it does not resolve or worsens. I don't have the book at home, otherwise I would post more specifics.

Oh, and I definitely don't ask specific symptoms unless it seems like a "true" head injury. Especially dizziness, EVERYONE says they are dizzy:sarcastic:

Got the book on Amazon: Pediatric Telephone Protocols: Office Version: 97815811

River Song, RN · Oct 6, 2017

But it all honesty, ANY head injury that arrives to an ER that isn't a skull fracture is pretty much going to be diagnosed as a concussion. If there's a bump and the kid c/o a bad headache, whether they actually have one or not, is dx'd as a concussion.
I call on all head injuries. I don't ask specific questions, as the answer will always be yes. I ask "how are you feeling?". Then I let the teacher know of things to watch for. I call home and let the parent know that if anything changes I will give them another call. And of course I fill out an accident report. The bane of my existence.

That is so true as to what will happen in the hospital. I used to work at a children's hospital in an observation unit/ED overflow and we would get the occasional closed head injury that they decided to keep overnight (almost always was a football or other sports injury). We would do frequent neuro checks overnight and generally a CT scan was only done if they lost consciousness or were symptomatic beyond a headache as generally they hit their head so obviously it's gonna hurt.

Unless things have changed in the last few years - which is totally possible with more emphasis on concussion - the ER generally just did some observation, neuro check and sent families home with a sheet similar to what my school gives out that would say if you see *this* then come back.

allnurses Guide · Oct 7, 2017

I'm not a school nurse but I am the mother of a high school athlete who competes in the two sports with the highest incidence for traumatic head injury. He plays football O-line and defensive tackle and he wrestles. He has had one concussion and two that his own doctor and a neurologist ruled out after referral from school. Head injury protocol in California is for student athletes. At the beginning of the year they have concussion baseline testing then they are reassessed if there is a suspected injury. If concussion is suspected there is a 14 day return to play protocol and well as physician clearance which can be the team doctor or the students private physician. I cant imagine having to do this to every kid who falls on the playground. The kids would never be in school.

My son is in line to get a full football scholarship so I have talked him into quitting wrestling in order to lower his chance of injury.

Hppy

GdBSN, RN · Oct 7, 2017

My trainer told me about Par CRR, an app he uses to help assess for concussion. It seems fairly easy to use, and allows you to print out the eval to give to parents to take with them to the physician.

MrNurse(x2), ADN · Oct 9, 2017

I do a SCAT assessment with every suspected head injury, it is part of my SNAP program, but you can also access it here:

http://physicians.cattonline.com/scat/

I print out a copy of the assessment to send to the physician. I have gotten a lot of positive feedback from the providers that it is appreciated.

ohiobobcat · Oct 10, 2017

I do a SCAT assessment with every suspected head injury, it is part of my SNAP program, but you can also access it here:
http://physicians.cattonline.com/scat/
I print out a copy of the assessment to send to the physician. I have gotten a lot of positive feedback from the providers that it is appreciated.

We switched from doing the full SCAT assessment to just the symptom checklist. I found I wasn't able to complete a full SCAT exam without getting interrupted 27 times by other students needing to be seen, and I wasn't sure how accurate my exam result were because of that. Our athletic trainer will use the full SCAT for the initial assessment and reassessment, but will use the symptom checklist score to see "where a student is at" in the middle his RTP protocol. I use the symptom checklist to see where non-student athletes are too, in their return to full academics post-concussion. We went with the SCAT vs the CDC Heads Up because of consistency with what our athletic trainer uses.

OhioBPH · Oct 10, 2017

For head injury, it says that a mild headache is normal and they don't need to be seen by their doctor unless it does not resolve or worsens. I don't have the book at home, otherwise I would post more specifics.

This is what I advise parents, but the 30 minute stay in my clinic is killing me.

I talked to the RN at the HS and she had some good advice to keep kids in class for more minor injuries. Like making the call as soon as a brief assessment is done and letting the parent chew them out for coming to the nurse for bumping their head on a desk.

OhioBPH · Oct 10, 2017

I also want to mention that I bumped my head last night and it hurt like a b*tch and I made my husband check 3 times that it wasn't bleeding. Oh boy did I have a headache. Someone should have sent me home.

AdobeRN · Oct 10, 2017

I also want to mention that I bumped my head last night and it hurt like a b*tch and I made my husband check 3 times that it wasn't bleeding. Oh boy did I have a headache. Someone should have sent me home.

LOL...I can relate. A friend of mine talked me into trying Roller Derby out - I wasn't even on skates for 5 minutes when I fell while standing still on my backside hitting the back of my head. I had an awful headache for the night and told my husband to check on me often thru the night - I had nightmares of having a concussion.

OldDude · Oct 10, 2017

I also want to mention that I bumped my head last night and it hurt like a b*tch and I made my husband check 3 times that it wasn't bleeding. Oh boy did I have a headache. Someone should have sent me home.

A little brain damage won't make any difference...How did you do on the CDC Concussion checklist?

OhioBPH · Oct 10, 2017

A little brain damage won't make any difference...How did you do on the CDC Concussion checklist?

Lol, just a headache. But like I said, I have vision problems and was pretty irratable so I would have gotten probably 4 or 5 symptoms. I should have seen a doctor for eval, I guess.