Today we are going to talk about concussion with Amy Koester. She is an emergency room nurse who cares for patients at Progress West Hospital.  Amy first off, good morning, welcome.

Good morning

We are headed into sports, football season and that is usually when we hear more about concussions although they can happen really in any situation. Let’s talk about that. Medically speaking, what causes a concussion? 

Some people get confused about it. Actually it can be caused by a couple of different things. One of the first things that can cause it is the obvious thing that people see; when you fall and hit your head. Some sort of traumatic injury to the head will cause someone to get a concussion. Another situation that can cause concussion is actually just the jarring motion of the head. An example would be: if the force of the jarring motion is hard enough in a car accident when you are rear ended causing your head to whip back and forth. This causes the brain to sort of shift back and forth in the head which can also cause a concussion.

What are some of the signs and symptoms that we have a concussions?

The most common one is confusion, memory loss, and little recollection of the events that took place. Another sign is just losing a few minutes of time when the incident took place, whether it was head on, helmet to helmet with football or whether it was a fall where you hit your head on the concrete. People are not really going to have a lot of information about what happened or maybe briefly say I blacked out for second. People can be confused. People can have headaches. There are also balance issues, dizziness and some people have nausea and vomiting, and feel very tired or act strangely. All of those are common symptoms of concussion.

If you suspect you have a concussion does that mean an immediate trip to the Emergency Room?

We always like people to seek medical attention if there is any sort of head injury because the problem is that over time, especially for example say sports, kids that play football, they may have repeated injuries to the head when they are making plays in football. Older people that fall and hit their head, they may have underlying issues that may exacerbate issues of concussions. We always think that medical care following any sort of head injury or suspected concussion is a good idea.

Kind of take me through the treatment process when they get to the hospital. What takes place?

There is a difference between a child coming in with a concussion and an adult coming in with a concussion. What I think parents need to understand and what we would like them to know is that we do want them to come in. What we won’t do for a child is that we won’t immediately go to a CAT scan. A lot of people think my kid has an injury, I think he has a concussion, we need a CAT scan. For children, we have found, over time that CAT scans are a lot of radiation. A lot of times for a child that comes in that has no other medical problems, depending on how far out we are from the event, we actually might sit and monitor that child for two to four hours and decide how they are acting. If they are acting appropriately, we are not going to scan that child’s head because you are not going to find anything on a CAT scan that is going to say that the child has a concussion. CAT scan looks for other things such as intracranial processes bleed and things like that. We like to monitor kids, so we like to say, we are comfortable thinking that this probably is a mild concussion but a CAT scan isn’t warranted because it is a lot of radiation. Our pediatricians are from Washington University and they have something that is called an algorithm that we just go down the list. Does the child have this, yes; then to this? This no, then don’t do that. We try to avoid radiation. With the adults, it is a little bit different because adults a lot of times have underlying issues. They are older. They have loss of consciousness. We tend to quickly go to CT scan for adults a lot of times depending on how far out from the injury they are and what sort of underlying medical issues they have.

Okay, well then what about the follow-up because I know that this is something that just doesn’t go away immediately?

You are correct because a lot of times issues with concussion can last a few days to a few weeks. I think that is the hardest part for a lot of people. What we do when somebody leaves is that we like them to participate in brain rest. This is something that is very hard for children to do especially now-a-days because there is a lot of television and IPads and things like that. We like them to participate in brain rest. We send them home and we ask them to limit the amount of television, limit reading, and limit screen time because the more your brain has to work the longer it is going to take for it to settle down and heal. We even sometimes will keep them home from school. You know kids might enjoy that. Going to school they have to think, they have to use their brain and that uses a lot of energy for the brain and that can actually continue to cause symptoms to stay and subsist. Adult wise it is sort of the same thing. Stay home from work a few days and sleep. Once you are starting to feel better and can tolerate small amounts of screen time and small amounts of activities then you can start to get back into daily activities but the brain rest is very, very important.

Last, but certainly not least; this is what is getting all the attention now days with NFL players. What are the lasting effects of concussion?

That is a big thing. I don’t know if you have taken part in watching the movie, Concussion. They talk about the long term effects on NFL players or anybody that sustains repeated head injuries over time. The thing about concussion is that people that stack up concussions over the years can have long lasting effects of trouble walking, memory problems, sleeping problems or mood changes, but again, isolated concussion aren’t necessarily going to cause those things. Repeated concussions over a life time will cause things like that to occur. When we have someone come in for concussion, we really like for them to consider the fact that when we say, rest your brain, please do this because we mean it. If they have repeated head injuries, especially back to back, when you put that kid back in football, like maybe one week later the head injuries that close together can add up to issues that are going to remain chronically over time.

So if I have one concussion, does that make me more susceptible to concussions for the rest of my life?

Not necessarily. If it is right after the first concussion, yes. If you have had one jarring brain injury and you go back to football and one week later you get another one, that is not necessarily a good thing because that can stack up over time. No, one concussion, does not make you more susceptible to concussion or brain injury over a lifetime.

If you want more information about this, I guess the best way is to contact Barnes-Jewish Hospital St. Peters or Progress West Hospital and they can get a hold of you. Hopefully they don’t have to see you but you are in the Emergency Room at Progress West Hospital right?

Yes I am.

Thanks for checking in with us.

You have a good day.