Originally Answered: What is the 1st thing an ER Dr. does to determine a concussion or serious head injury?
When someone with a potential concussion sees a doctor, the doctor will ask for information about how the head injury occurred and ask very basic questions such as, "What year is it?" This is to make sure the patient is thinking clearly. The neurological exam will also screen for problems with reflexes, vision/hearing, memory loss, and coordination. X-rays will usually be taken, and in some situations a CT scan or MRI is warranted to make sure there is not excessive internal bleeding. If the patient is unresponsive, as you mention above, the neurological exam will quickly proceed, and then CT or MRI studies will be performed.
In most cases, the patient will be sent home the same day with instructions for how someone should monitor them. This may include waking the person with the head injury every few hours through the night just to be sure that they are able to regain normal consciousness, and watching for the initial symptoms mentioned above. Other times, an overnight stay in the hospital is necessary to be observed by medical personnel. Only in severe cases are more drastic measures needed.
There are five different grades into which a concussion can be classified, depend on its severity. A grade I concussion is the least serious and displays only minor symptoms, such as brief confusion. Many people have had a grade I concussion without realizing it. Someone with a grade II concussion typically has symptoms that last longer than fifteen minutes, brief memory loss, and confusion. The more severe grades display some or all of the more minor symptoms, as well loss of consciousness that lasts less than five for grade III, between five and ten minutes for grade IV, and more than ten minutes for grade V.
The classification system is important because it determines how quickly the patient can resume normal activities. There are also special restrictions for people who suffer multiple concussions within a given period of time, depending on the grade of each concussion. Injuries on the front of the brain are usually less problematic than those to the back, left side, or right side of the brain.
Someone who has been diagnosed with a concussion, especially of a more severe grade, should be monitored to see how long the symptoms last. Postconcussion syndrome is when the initial signs of memory loss, confusion, et cetera, are still present a couple of months after the injury. A doctor should be aware of lingering symptoms so that proper action can be taken. Some patients will require rehabilitation therapy.