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Emergency Department Discharge Instructions

Head injury with a concussion

Emergency Care Discharge Instructions

Instruction summary

Concussions are common after a strong head injury. For the vast majority of people, concussions last several weeks. Concussion symptoms vary from person to person. They usually involve headaches, difficulty concentrating, feeling like you are in a fog, and/or speaking more slowly than usual for you. If the concussion symptoms last longer than two weeks, follow-up with your family doctor.

While your brain is healing, a second injury (even if it is minor) can have catastrophic consequences. This is called “Second Impact Syndrome.” It is extremely rare, but has been reported when an athlete who had a concussion goes back to playing their sport too early, and has a second (even very minor) head injury. These patients may die from the second injury. So it is extremely important that you avoid having any more head injuries when you have a concussion.

For the first two days after the injury, avoid doing any reading, and anything that makes you concentrate hard. This includes texting, reading on a computer screen, laptop, or smartphone, reading books, magazine text, or newspapers (all of these things make your brain work, when it needs rest). After that limit the amount of computer/cellphone/laptop use, cutting back still further if your symptoms worsen.

If you had a CT scan and there was no evidence of bleeding on the scan, you do not need to return to the ER unless you are taking a blood thinner like warfarin (Coumadin), apixaban (Eliquis), dabigatran (Pradaxa), or rivaroxaban (Xarelto). These medications are blood thinners and you can have more bleeding if you are taking these medications.

If you had the injury right before bedtime, it might be helpful to have someone wake you up once during the night to make sure that you are okay (there is no scientific evidence that this helps, but there is no harm in it either). If the injury happened in the early evening or earlier, this is not necessary, since you’ve been observed for 4-6 hours before heading to bed.

Reasons to return to the ER
  1. Confusion or increasing drowsiness
  2. Severe headache and/or vomiting
  3. Numbness or weakness in one arm or leg
  4. Seizure