PrepperMed 101: Concussion

There’s been a lot of talk in Sports World lately about concussion, as the sports world comes at last to the amazing conclusion that smashing your brain is bad for you. Emergency situations, where people might have to do more vigorous and unusual things and where the possibility of violence is increased, have more opportunities for smashing one’s brain than normal living; so it’s a topic preppers should know something about.

Note: I’m not a physician.  These aren’t medical recommendations, they are ideas coming from a physiologist who knows a couple of things about how bodies work. If you don’t get real medical attention for someone who you suspect has a significant brain injury when it’s possible to get that care, you’re doing them a real disservice, imo.

Causing concussion

First, lets kill a misleading myth: It is not true that if you’re not knocked out, you’re ok. Brain injuries can occur with or without unconsciousness. Yeah, if you don’t go unconscious, it’s called ‘minor’ traumatic brain injury (mTBI), but the real operative words there are traumatic brain injury (TBI). Concussions are a big deal with or without unconsciousness.

Most obviously, hard contact to the head can cause concussion, with or without damage to the skull bones. The brain floats inside the skull in cerebrospinal fluid, which supports the brain and serves as a shock absorber. If the skull changes momentum suddenly (say by slamming into something), the cushion isn’t enough and the brain slams into the inside of the skull and essentially bruises. That’s a TBI, commonly called a concussion.

A brain injury can also occur without the head hitting anything at all.  In whiplash, the neck snapping the head forward or back can cause enough change of momentum to bruise the brain. Shaken baby syndrome is an example of this kind of injury.

Rotational brain injuries can also happen, although it takes a lot of tumbling and twisting of the head to cause this.  A person tumbling head over heels down a slope or being rolled in a car crash are likely ways to get these injuries. Rotational injuries tend to affect a lot of brain areas as connections between brain cells are stretched and torn, but they don’t tend to affect any one area as badly as does a bruise.

Not all concussions show up right away

Symptoms of brain bruising (bruising meaning the tissue is mashed and there’s a lot of very small local bleeding events) tend to show up pretty much immediately. Sometimes though the original injury tore a blood vessel or blocked one of the channels where the cerebrospinal fluid is supposed to flow. In these cases fluid pressure builds up over time (hours or a few days) and gradually squishes the soft brain against the hard skull, damaging the brain.

You might have heard that you shouldn’t let a person with a suspected concussion go to sleep for several hours thereafter. Is sleep bad for them? No. Its just that when they’re sleeping you can’t tell if they develop mental impairments or even slip into a coma. The idea is that you talk to them now and again and make sure they keep tracking, thinking clearly, and so forth; so if their condition deteriorates you notice and can take them to the emergency room.

That line of reasoning has some logic to it — if there’s an emergency room you can get to.  If there isn’t … well, there’s nothing I know of to be done that you shouldn’t already have been doing.

Recognizing concussion

If  someone is knocked unconscious, take it as given there’s some brain injury. Cognitive impairment right after the event is also a big clue – think of the old chestnut of asking someone what day of the week it is or where they are.

You have to be careful about these tests though. I remember one sporting event where a friend took a hard hit to the head, and someone asked her who the Vice President was. A voice whispered from the back “Does she ever know that?” Good point. Giving each person a concussion test while they’re well, for later score comparison, is most accurate.  Most of us don’t do that, but at least keep in mind how ‘with it’ the person is normally.

The range of symptoms that indicate concussion could make you dizzy all by itself. Effects vary by which region of the brain was affected and the intensity of the effect. Besides the well-known cognitive problems, symptoms may include problems from balance to mood to headache to vision issues to sleep disturbance (too much or too little) to vomiting …. basically any weirdness after bouncing the head around indicates possible concussion. (2)

The pupils of their eyes might also not change size when a penlight is shined in and out of them, or change slowly, or have one side not react as the other does.

There are a lot of tests out there to guide you in checking for the the most common problems. Read one and you’ll know what sorts of problems you’re looking for. Click here for one from the CDC. (3)  It’s also downloadable. Giving the same test right after injury then periodically thereafter helps track the person’s recovery.

Dealing with concussion

I don’t say ‘treating’ because there’s often nothing to be done; particularly if you don’t happen to be a neurosurgeon. The main point of diagnosis is to be aware of where the person is and guide their return to activity.

When there is serious brain injury, it often gets worse over time as the swelling or the pressure from blood or cerebrospinal fluid builds up. The only good treatments for that are surgical, and it’s not procedures I can visualize a barely-trained prepper managing, so there’s no point in going into it here.

What you can do is:

• Understand the person has significant limitations on what they can do, physically and cognitively, and no amount of will on their part will fix that.
• Give physical and cognitive rest. Having a concussion is boring; it’s best if the person doesn’t even read or watch TV.
• Plan for a recovery time that might be extended.  Concussion symptoms can hang on for a disturbing amount of time. Weeks is common; years is possible. Retest periodically to guide their return to activity.
• Know that symptoms may pop back up after going away.  This is most often associated with exertion.

Returning to activity

The most common recommendation is that once symptoms have gone away, the person can start returning to normal activity.  Not just jump right in though; ease back in and be ready to pull back if symptoms crop back up.  Returning to mental and aerobic activities comes earlier in many sources’ suggested sequence than weightlifting. (1,2,3)

Every source I’ve ever read on the topic has suggested being very conservative about activities that could cause re-injury. They say that the more concussions one has had, the more likely new concussions become. It’s certainly been observed that someone fresh off of one concussion seems to collect another soon after due to hits that didn’t look hard enough to be a problem.

But I wouldn’t do this for a person who’d taken trauma to the head:

If I had any suspicion that someone might have brain injury, I wouldn’t offer them any drug that ‘thins the blood’ as the expression goes: drugs that discourage blood clotting, also called anticoagulants. They might want some too, because many of the over-the-counter pain remedies also serve to discourage clotting.  Examples include …aw heck, it’s easier to turn this around.  Acetominophen (such as Tylenol, among others) is the main over-the-counter pain med that doesn’t encourage bleeding.

The reasoning is pretty clear:  Some of the brain injury is caused by pressure from bleeding out of the damaged blood vessels.  If the person takes drugs that slow clotting, they bleed more from the same amount of damage and are at greater risk of brain injury.

Do I read about docs saying this about ‘no blood thinners’? No, they all say you should seek professional medical help if you really suspect brain injury.  That’s a great plan — when it is possible.  As preppers, we know it’s not always possible.

An ounce of prevention

Since brain injuries are so tough to deal with, especially when you can’t go the MRI + neurosurgeon route, it’s triply important to avoid this kind of injury during emergencies. Not getting shot in the head is always great advice. So is not getting into fights unless absolutely necessary.  Here’s my best tip you might not have thought of though:

Salty and I are big believers in avoiding injury.  You can read and listen to more about that here.

Bonus: See the face screen on the helmet? Having something end up in your eye is almost as much fun as bruising your brain… and as our team’s designated medic, it’s a situation I fervently hope to never face.

1)  Concussion Diagnosis and Management Best Practices. NCAA. http://www.ncaa.org/sport-science-institute/concussion-diagnosis-and-management-best-practices

2) Concussion. 2017. American Orthopaedic Society for Sports Medicine. https://www.stopsportsinjuries.org/STOP/Prevent_Injuries/Concussion.aspx

3) HEADS UP. 2017. Centers for Disease Control and Prevention. https://www.cdc.gov/headsup/index.html