Was this a concussion?

[NurseBeans, BSN, RN, EMT-B]

So I had a kid in at about 1 hour before dismissal today, who had a headache since recess. Which was about 1 hour prior. He casually mentioned that he was on the swing at recess and he hit another kid. No head bump, just his body on the swing hit another kid who was standing. I gave motrin for the headache and let him sit for a little while. The motrin was not working 30 minutes later, so I started asking concussion questions. He was alert and had no real symptoms, except something felt strange to me. But he's a bit of a strange kid. I wrote my assessment down and left mom a voicemail. She's an ER nurse locally so I was thinking she would not only understand my notes, but also feel comfortable assessing kid later. She never called back and I ended up letting the kid go at dismissal, but now I'm questioning myself.

Did I royally mess this up? My other thought was dehydration since it was quite warm today and he looked red in the face. But still.

[moreoreo]

I understand the unnerving feeling of something "feeling strange" when you haven't pinpointed the reason why. I don't think you messed anything up, though. If a child is alert, calm, PERRL, not nauseous or dizzy, and especially if he didn't hit his head (I can see why you would be worried about maybe whiplash from the collision with the other student but if he and the other child did not come right after that then I wouldn't think it was that hard of a hit? But children are sent to me for literally everything) then I wouldn't be worried.

How old was he? How does he go home at the end of the day? I suppose if this were a kindergartener who rides the bus I may have persisted in calling the parent to request pick up but to me it doesn't sound like you did anything wrong.

[Farawyn]

I don't have a standing order for ibuprofen, so I probably wouldn't have done that.

Otherwise, yea, you followed through. You called the mom, you observed the kid, you charted.

I would maybe do an IR to cover your hiney if you are that concerned. A follow up phone call with the mom.

I call for every head injury. I've been burned too many times.

Let us know!

[JenTheSchoolRN, BSN, RN]

I don't have a standing order for ibuprofen, so I probably wouldn't have done that.

Otherwise, yea, you followed through. You called the mom, you observed the kid, you charted.

I would maybe do an IR to cover your hiney if you are that concerned. A follow up phone call with the mom.

I call for every head injury. I've been burned too many times.

Let us know!

Agree with Far. If the student is in school today, I would likely follow-up with a check-in, then a call to Mom (after student left my office if seem well). If student is absent, I would call home with a follow-up, check-in call. Oddly enough, parents seem to be always surprised when I do those and very appreciative :).

[Flare, ASN, BSN]

I think you handled it fine. If the kid was fine neuro-wise during your checks but something was still off, then it's possible that something was going on. CYA rules apply here. If mom doesn't follow up with you, then you can always do a quick courtesy call.

[tining, BSN, RN]

FYI - Motrin is contraindicated with concussions, Tylenol is the go to med.

From The Mayo Clinic:

For headaches with head injuries, try taking a pain reliever such as acetaminophen (Tylenol, others). Avoid other pain relievers such as ibuprofen (Advil, Motrin IB, others) and aspirin, as these medications may increase the risk of bleeding.

This information may not be widely known, and I am not trying to dig at you when you feel unsure.

Reach out to mom again or ask the student to see you today.

[OyWithThePoodles, RN]

FYI - Motrin is contraindicated with concussions, Tylenol is the go to med.

I recently had my own two year old in a pediatric ER with a concussion, they not only gave him Ibuprofen there, but wrote a rx for some as well (we didn't need the rx but they wrote in nonetheless) and at his post ER follow up with his primary pediatrician they also recommended Ibuprofen.

[NurseBeans, BSN, RN, EMT-B]

I mean either way I didn't suspect concussion at all until after meds.

[kidzcare]

I think you did fine. You assessed and charted what you found and called to alert the parent. It is not the nurse's job to diagnose a concussion.

I agree that a follow up call is a good idea. Parents love them and since mom is a nurse there will likely be professional appreciation.

[OyWithThePoodles, RN]

It sounds like you did everything right, you tried to notify mom. I notify on any head injury, and if they are symptomatic I make sure I talk to someone and usually have them pick them up.

Of course you will always have your dramatic kids who've suddenly been struck with amnesia when mom picks them up, or who've forgotten how to walk. (Two separate kiddos in the last two weeks have done this.) Scares the crap out of the moms, usually I want to tell them to cut it out, but I don't.

[MHDNURSE]

Any updates on the kid? Did his mom end up calling you back?

[MrNurse(x2), ADN]

Had one yesterday with a soft kickball to her nose state that she had a headache afterward. This is my actress from the last two years who loves to fake concussions. Told mom I have to have her cleared and gave her one last chance to NOT go to the doctor, nope. Of course she cleared.