GWU is very nice, but I'm biased from attending programs there!
See... The bit about 'a concussed person might not wake up' is something that I never really bought into. What makes more sense to me is that you can tell degree of damage to the brain by keeping the person awake and talking - if I have a patient with a possible concussion, and I suddenly start seeing them exhibiting a droop or slurred speech, or their pupils no longer react the same to light, or they start puking... That indicates damage to different regions of the brain, and will affect what I do and where we go with the patient. Anything going into an ER I want to keep the patient awake for the trip if I can because that's the best way to judge any changes in their overall condition. If someone was up and talking to me, but slow to respond, and ends up falling asleep and my bottom-of-the-barrel painful stimuli don't wake them up, then I'd be concerned about brain stem damage and we'd go to a neuro center immediately. Not all concussions need to go to a neuro center; as long as they go somewhere that has MRI and CT capabilities, you can rule out bleeding on the brain. If you're not acting right or something changes, I don't care, we're going for a 24/7 neuro consult. All hospitals have neuro consult over the phone, but an actual neuro center has neuro there most of the time to provide better care.
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Date: 2012-06-22 08:22 pm (UTC)See... The bit about 'a concussed person might not wake up' is something that I never really bought into. What makes more sense to me is that you can tell degree of damage to the brain by keeping the person awake and talking - if I have a patient with a possible concussion, and I suddenly start seeing them exhibiting a droop or slurred speech, or their pupils no longer react the same to light, or they start puking... That indicates damage to different regions of the brain, and will affect what I do and where we go with the patient. Anything going into an ER I want to keep the patient awake for the trip if I can because that's the best way to judge any changes in their overall condition. If someone was up and talking to me, but slow to respond, and ends up falling asleep and my bottom-of-the-barrel painful stimuli don't wake them up, then I'd be concerned about brain stem damage and we'd go to a neuro center immediately. Not all concussions need to go to a neuro center; as long as they go somewhere that has MRI and CT capabilities, you can rule out bleeding on the brain. If you're not acting right or something changes, I don't care, we're going for a 24/7 neuro consult. All hospitals have neuro consult over the phone, but an actual neuro center has neuro there most of the time to provide better care.