A concussion is a mild traumatic brain injury that results from a jolt or blow to the head or body, causing the brain to move rapidly inside the skull. This sudden movement can lead to temporary changes in brain function, often without any loss of consciousness. Recognizing the specific signs that indicate a more serious injury is paramount for safety. This helps determine whether the situation requires an immediate trip to the emergency room or if a scheduled doctor’s visit is appropriate.
Immediate Emergency Red Flags
A serious head injury, such as a skull fracture or bleeding inside the skull, must be ruled out immediately if certain symptoms appear. These danger signs indicate rapidly increasing pressure within the brain and require a call to 911 or an immediate trip to the nearest emergency department. Persistent, severe, or worsening headaches should prompt immediate concern, especially if the pain does not respond to standard over-the-counter medication.
Any seizure or convulsion after the injury signals a significant disruption of normal brain activity. Repeated vomiting, typically defined as two or more episodes, is a physical manifestation of elevated intracranial pressure. Watch for any clear or bloody fluid leaking from the ears or nose, which may indicate a skull base fracture and leakage of cerebrospinal fluid.
Neurological changes that affect consciousness or motor function are also red flags. This includes slurred speech, new weakness or numbness in the arms or legs, or significant difficulty with balance or coordination. A person who is unusually drowsy, cannot be fully awakened, or has increasing difficulty staying awake requires emergency medical attention. A difference in pupil size, where one pupil appears noticeably larger than the other, suggests pressure on the brainstem that must be addressed urgently.
Symptoms Requiring Non-ER Medical Attention
Many common concussion symptoms are not life-threatening but still require medical evaluation within 24 to 48 hours of the injury. These symptoms relate to the functional disruption caused by the injury and can be managed in an urgent care clinic or by a primary care provider. A mild, persistent headache or a general feeling of fogginess or being slowed down often falls into this category.
Patients may experience subtle sensory disturbances, such as increased sensitivity to bright lights or loud noises. Dizziness, mild unsteadiness, or temporary balance problems can occur. Minor short-term memory issues, such as amnesia surrounding the moments immediately before or after the impact, are also typical for a concussion.
It is important to seek non-emergency medical attention for a formal diagnosis and a recovery plan, even if symptoms are mild. This initial medical visit helps confirm the injury and establishes a baseline for monitoring the recovery process. If any of these stable symptoms suddenly worsen rapidly or transition into one of the immediate red flags, proceed to the emergency room without hesitation.
What to Expect During ER Assessment
When arriving at the emergency department, the primary goal is to rule out a serious, life-threatening injury like a brain bleed or skull fracture. The assessment begins with a neurological examination to evaluate reflexes, coordination, strength, and balance. The healthcare provider will also conduct cognitive testing, checking orientation, short-term memory, and concentration.
A scale like the Glasgow Coma Scale (GCS) may be used to provide a standardized measure of the level of consciousness and neurological responsiveness. Imaging tests, such as a Computerized Tomography (CT) scan, are central to the assessment but are not necessary for every patient. A CT scan visualizes bone fractures and acute bleeding inside the skull, which are the main concerns with severe head trauma.
A simple concussion itself does not show up on a CT scan, as the injury is functional and metabolic, not structural. Therefore, imaging is reserved for patients presenting with red flag symptoms or specific risk factors, such as being on blood thinners. If the imaging is clear and no red flags are present, the patient is usually discharged with specific instructions for at-home monitoring and care.
Safe At-Home Monitoring and Care
For those discharged from the ER or advised to manage symptoms at home, recovery centers on rest. This involves both cognitive rest, reducing mentally demanding tasks like schoolwork or excessive screen time, and physical rest, avoiding strenuous activity. Light activity, such as short walks, is encouraged after the initial 24 to 48 hours, but any activity that significantly increases symptoms should be stopped.
Pain management for a headache should be approached cautiously. It is recommended to use acetaminophen rather than non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin, unless cleared by a doctor. NSAIDs can potentially increase the risk of bleeding in the first hours after an injury, so they are best avoided initially.
Having a reliable “concussion buddy” or caregiver is highly recommended, especially for the first 24 hours, to watch for subtle changes. The caregiver should check on the patient periodically throughout the night, ensuring they can be easily roused and are not becoming increasingly confused or difficult to wake. If any symptom from the emergency list appears or worsens during this monitoring period, immediate return to the emergency department is necessary.