Concussion

[SP5IC]

How does one know if one has one? I am asking for an officer :)

[Roguish Lawyer]

How does one know if one has one? I am asking for an officer :)

Excellent question. :munchin

[Doc]

http://www.merck.com/mrkshared/CVMHighLight?file=/mrkshared/mmanual/section14/chapter175/175a.jsp%3Fregion%3Dmerckcom&word=concussion&domain=www.merck.com#hl_anchor

[swatsurgeon]

now for the important question...how severe was it?
We grade them according to severity (duration of unconsciousness and type of symptoms) and 'suggest' that patients with the more severe level of concussion NOT participate with driving, operating heavy machinery, firearms or explosives for a period of time.
It's a sad time when someone with sound medical knowledge "clears" someone to immediately return to a dangerous activity after a severe concussion....certain circumstances may dictate the need to return, i.e., hot zone in a sand box, but otherwise in civilian life they would be removed from their activity for a prescribed period of time for their safety as well as the safety of others. Anyone remember 2 yrs. ago in NASCAR, one of the big name drivers hit a wall, was unconscious for 3-5 minutes and they let him return to driving in a back up car!!!! he lasted about 2-3 more laps then drove into the pit area at about 180 mph....couldn't stop! I'll try to attach some stats and suggestions from a presentation I give on this.

[swatsurgeon]

Here are the clinical definitions and recommended Tx's....CIVILIAN WORLD!!!– Traumatic Brain Injury’s: Concussion

– Mild (grade 1)
 confusion with no amnesia or loss of consciousness
– Moderate (grade 2)
 confusion with amnesia, no loss of consciousness
– Severe (grade 3)
– any loss of consciousness

– Other nomenclature system
– mild :concussion
 at least one of these
– any LOC
– any amnesia
– any altered mental status
– any focal neurological deficit
– +/- transient symptoms
– moderate
 + LOC with prolonged confusion
– physical and/or cognitive and/or behavioral impairments
• +/- permanent
– severe
 coma/LOC: variable time
– likely permanent disabilities




Define the Treatments
 Grade 1 (confusion with no amnesia or LOC)
– if confusion clears within 20-30 minutes, than allow return to activity OR within 1 week of being without symptoms
– after a 2nd mild concussion in the same 6 month period, do not return to activity that may lead to another concussion for 2 weeks
 must be asymptomatic at least 1 week and have a negative CT scan
– if a third mild concussion occurs, terminate risky activities for the year
 may return next year if asymptomatic
– (?) neuropsychology evaluation
Define the Treatments
 Grade 2 (confusion with amnesia, no LOC)
– return to activity only after appropriate evaluation (CT scan, +/- neuropsych eval.) and asymptomatic for 1 week
– after 2nd moderate concussion, return to activity only after asymptomatic for 1 month and CT documented as normal
– if a 3rd occurs, terminate the activity for 1 year and consider termination of contact sports or other ‘high risk’ activities indefinitely
Define the Treatments
 Grade 3 (any LOC)
– urgent transport to trauma center
– may return to activity after asymptomatic for at least 2 weeks
 if LOC was < 1 minute and CT normal
– if LOC > 1 minute
 no return to high risk activity for 1 month and must be asymptomatic for at least 2 weeks
– if second episode LOC, terminate contact sports/high risk activity indefinitely

[ccrn]

‘No head injury is too trivial to ignore’ Hippocrates, 460–377 BC

The term consussion and mild traumatic brain injury (MTBI) are sometimes used interchangeabley.

However you want to call it they can have significant consequenses within the first year. A quick review of some CDC statistics reveals up to 15% experiencing some form of disability one year out. Divorce and job loss within the first year post MTBI has been studied also. In nursing school they gave us a figure on this but I recently through all of that out and no longer have the number. It did leave an impression though.

While George S Patton has admitted to manufacturing some of his WW2 personality in order to more effectively lead, some have speculated that consussions recieved while serving in the cavalry and playing polo contributed to changes in personality compare to his younger years.

A hx of consussions makes one more susceptible and is important to note in an h&p-

FWIW

[Rumblyguts]

Caught a little bit of this program on MN Public Radio. Only caught about 15 minutes, but the focus seemed to be on MBTI.

What cuaght my attention was how the concusion can be "transmitted" via blood pressure, and how the accumulation of "bell-ringers" from blasts add up (not sure if training was included, or jsut combat). I belive that she said that many of the participants had around 19 such instances.

One of the Dr's stated that her light-bulb moment occurred when she had several young soldiers come through who automatically pulled out notepads so they could remember the conversation.


Traumatic brain injuries: Wounds of a modern war
Broadcast: Midmorning, 07/13/2010, 9:06 a.m.
http://minnesota.publicradio.org/display/web/2010/07/13/midmorning1

The military has taken heat recently for its handling of soldiers and veterans with blast-induced traumatic brain injuries. Three leading TBI specialists discuss the difficulties of diagnosing and treating the disorder.

Guests
Ibolja Cernak, M.D.: Medical Director, Biomedicine Business Area, Johns Hopkins University Applied Physics Laboratory

Elaine Peskind, M.D.: Director of Clinical Research for Mental Health Services at the V.A. Hospital of Puget Sound, and a professor in the department of psychiatry at the University of Washington School of Medicine.

James Kelly, M.D.: Director of the Department of Defense's new National Intrepid Center of Excellence in Bethesda, Md.

[wook]

Potential for Second Impact Syndrome (diffuse cerebral swelling), is rare but often fatal effect from a second concussion before the symptoms of the first concussion have resolved.



Wook

[MILON]

Thanks for that post Rumblyguts. I listened to that program yesterday.

MPR and NPR has had quite a bit of coverage on head injuries sustained by soldiers, subsequent effects and issues the Army has in dealing with it.

Link below to a search on NPR.

http://www.npr.org/search/index.php?searchinput=Mild+Traumatic+Brain+Injury

Also some stuff on Frontline's Website.

http://www.pbs.org/wgbh/pages/frontline/gsearch.html?q=mild+traumatic+brain+injury

Milon

[MILON]

Soldiers with Brain Injuries at Higher Risk for Epilepsy Decades Later

http://www.newswise.com/articles/view/566431/?sc=dwhp