Cook Drops The Ball

This week’s guest columnists are Drs. Jordan Conway and Amir Farizani, Family Practice residents at the University Hospital and Clinics here in Lafayette.

Watching the instant replay, I saw exactly when Jared Cook lost consciousness.  In yesterday’s Saints game against the 49ers, he made a great catch, and hung onto the ball through his fall.  But as he lands he’s hit in the helmet.  His hands go slack, and the ball rolls away. To return to play, Cook will undergo daily neurological evaluations while his brain heals. Then he must stay well under increasingly challenging conditions- during exercise, then drills, then scrimmaging.

Concussion is defined as a brain blow followed by loss of consciousness, headache, nausea, trouble with balance or coordination, memory loss, disorientation, and slowed thinking.  Bright lights and loud sounds can make it worse.  Irritability, depression, anxiety, and mood swings are also part of the picture.  Concussion isn’t brain bleeding or skull fractures.  It doesn’t show up on scans- it’s simply defined by the symptoms.

It’s important to immediately remove an athlete with suspected concussion from the game. Continued blows can worsen the injury; prolonging recovery, worsening pain, and even risking brain swelling and death.  It’s sometimes a while before concussions are obvious to coaches, or the player himself.  Thus with any suspected injury, the player needs a sideline evaluation with one of several tools approved by the league- NFL, NCAA, LHSAA.  Don’t wait until the player is staggering about, slurring his words, and vomiting.

If a player is suspected to have concussion, that’s it for the game.  He needs a more thorough evaluation by his doctor, plenty of rest, pain medicines, and time.  The doctor determines fitness to return to play.  Sometimes the simplest things can bring headaches back- trying to read, math homework, exercise.  It can take weeks for an athlete to be ready to play again.

These rules go for all sports with head injury risks- soccer, cheerleading (lots of throwing and falls off pyramids!), basketball, baseball and softball.  No one’s invented an attractive cheerleading helmet yet, any takers?

Kids are constantly bonking their heads, like when my son was learning to walk.  He would take steps along the couch, holding on for support.  Then he’d toddle away, swaying back and forth.  Once he tipped forward and smacked his forehead on the floor.  My wife squeaked, snatched him up, and looked to me for help.  I froze, mouth gaping. Oh, right, I’m a doctor!  Then I remembered my time in the Pediatric Emergency Department.

In the ER we have guidelines about which head injuries are fine, and which need CT scans for brain bleeding.  There’s separate guidelines for kids under 2 years, and those over 2.  My son was in the under 2 category, so these told me he was okay: he wasn’t knocked out, crying immediately after flopping down. Then later he acted fine. This wasn’t a severe injury mechanism, for his age meaning falls greater than 3 feet; he’s under 2 feet tall.  He had no scalp swelling or other signs of a skull fracture.  Thus I knew he didn’t need an ER visit.  Myth buster- no need to wake him up every hour at night to check on him either.

The criteria are a little different for kids over 2.  Notice I didn’t worry about vomiting in my son.  Toddlers vomit easily, especially when they’re upset.  Vomiting has no correlation with bleeding at that age.  However, over age 2, vomiting is on the worry list.  Other signs are being knocked out and/or having a really bad headache.  Indications of skull fracture are “raccoon sign” (black eyes without a blow to the face) or “battle sign” (bruising behind the ears).  If the child is acting dazed and confused (worse than usual, for your teenagers!), that’s concerning.  Finally, if there’s a severe mechanism of injury, like falls greater than 5 feet, blows by a high-impact object like a thrown baseball, or getting hit by a car while walking or riding a bike without a helmet, get checked!

We don’t CT scan every kid who comes into the ER with a smacked noggin.  CT scans carry a small risk of causing cancer by their radiation dose.  We see all severities of injuries, and with experience and these guidelines can make the scan-or-not call with a cool head. If your kid needs it, he’ll get it.  If not, whew!

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