Care of the Patient with a Head Injury

EMERGENCY DEPARTMENT PATIENT INFORMATION FOR YOUR CARE

Care of the Patient with a Head Injury (General instructions, Pediatric HI, Post-concussion, Return to activity) □ General Instructions

1. At the present time there is no evidence that there is serious danger from the head injury. However, careful attention for the next 24 hours is advised. 2. It is common for patients to have nagging symptoms after a head injury. This may include mild headache, mild nausea, mild disorientation, and generally feeling unwell. The key is that these symptoms are mild, as opposed to the ones listed below. 3. If the patient complains of mild headache, it is okay to give them over-the-counter medication, such as acetaminophen (e.g. Tylenol). 4. Make sure you rest for the next 24-48 hours, or until you are feeling normal again. 5. Return to the ED immediately if any of the following occur: a. Excessive, inappropriate drowsiness or unable to awaken the patient b. Persistent vomiting (more than twice) c. Increasingly severe headache d. Leakage of clear or bloody fluid from nose or ears e. Confusion or disorientation f. Seizures g. New onset of weakness or clumsiness in arms or legs. 6. The common recommendation of waking patients every 1-2 hours after a head injury is controversial. Discuss this with your ED physician. □ Child with a Head Injury

1. Read the instructions above under “General Instructions”. 2. The signs that should make you concerned are the same in children as in adults. The problem is that you may have a harder time picking them up, since children have more naps, may be disoriented at the best of times, and may not be able to tell you what they are feeling. 3. In addition to the list above (Return to the ED immediately if …), if you notice any significant change in your child’s behaviour, i.e. “they are just not right”, then bring them back to be checked again.

These instructions are not intended to be all-inclusive, and may not cover all possibilities. If a new problem develops, or if you have any further concerns or questions please contact your primary care provider, Telehealth Ontario at (866) 797-0000, or return to the ER.

Royal Victoria Hospital of Barrie, 201 Georgian Drive, Barrie, Ontario L4M 6M2 (705) 728-9802 www.rvh.on.ca RVH-3294 (Rev Nov 29, 2006) EMERGENCY DEPARTMENT PATIENT INFORMATION FOR YOUR CARE

□ Post Head Injury Symptoms (Post-concussion Syndrome)

1. Some patients complain about symptoms persisting after their head injury. These symptoms are a sign that your brain has not recovered fully, and needs more time. They may include: a. Mild headache b. Mild nausea c. Mild episodes of disorientation d. Colours or smells seem “off” e. Can’t concentrate like usual f. Irritable mood or behaviour. 2. You should make sure you are getting enough rest. You may take over-the-counter medication, such as acetaminophen (e.g. Tylenol). Avoid alcohol and strenuous activity. 3. Read instructions under “Return to Activity after Head Injury”.

□ Return to Activity after Head Injury (includes work, play, school and sports)

1. Like any other part of your body that is hurt, your brain needs time to recover. If you return to activity too soon, it can aggravate the original injury. 2. The simple instruction is that you should rest until all of your symptoms have resolved. This includes any headache, as well as any of the more subtle ones listed above under “Post Head Injury Symptoms (Post-concussion Syndrome)”. 3. When all of your symptoms have resolved while you are resting, you may return to light activity (e.g. walking, calm play indoors, desk work). 4. If you have no symptoms during or after light activity, you may progress to the next step as outlined below. If at any time you develop a recurrence of your symptoms during or after the activity, then you must return to the step before. 1. Total rest, no activity. Remember that reading and concentrating count as activity for your brain. 2. Light activity or exercise. 3. Usual level of activity if sedentary (e.g desk work, classroom). Light specific activity if more active or sports (e.g light running, light duties at work). 4. Usual level of activity for more active jobs or sports. NO body contact (e.g. hockey, football). 5. Usual activity, including body contact. 5. Your safe return to sports can be more specifically guided by calling the Active Health Sports Medicine Centre where you will be seen and assessed by a Sports Medicine physician. Special testing can be performed to better manage your return to sports. Ask your ER doctor about a referral, or call 725-1050 for an appointment.

These instructions are not intended to be all-inclusive, and may not cover all possibilities. If a new problem develops, or if you have any further concerns or questions please contact your primary care provider, Telehealth Ontario at (866) 797-0000, or return to the ER.

Royal Victoria Hospital of Barrie, 201 Georgian Drive, Barrie, Ontario L4M 6M2 (705) 728-9802 www.rvh.on.ca RVH-3294 (Rev Nov 29, 2006)