PDA

View Full Version : Questions about concussions



Tornadoboy
12-07-2017, 07:48 AM
I've got a female protag whom I need to be knocked out or at least completely dazed and only semi-conscious for about an hour or two, she bangs her head off her car door's window during a crash and is left with a knot above her ear. I don't want her too badly injured, but for the story I need this to happen.

So here's my questions:

- I know vomiting is common for people with concussions but I'd rather not have her do that given the situation, so I was wondering if it is believable that she wouldn't vomit having been hit hard enough to do what I described above?

- Is it believable to have her not bleed if she hit her head that hard?

- Is it believable that she more or less could mostly return to normal within say 8 to 10 hours, sleeping a good portion of that time?

- What's the story with keeping people awake with concussions? I know they used to tell you not to let the person sleep, but isn't that just so as to watch for symptoms a serious brain injury? My male protag knows he's not in a position to do anything for her if she does have a serious problem, and I'm thinking of his logic being that if she was going to die from say a brain bleed or something that he'd rather it happen in her sleep.

tiddlywinks
12-07-2017, 07:59 AM
I know from personal family experience that not all people vomit upon receiving a concussion. In fact, said person has never vomited, and they've had multiple concussions, both mild and severe.

As to the bleeding, I can't attest to that part. Would she have hit the window hard enough to crack it? In which case, she might be cut. Said person mentioned above was once in a car accident and actually slammed their head into the roof of the car. No bleeding. (Again, concussion) For that to work, though, you'd need to think about the angle of the accident and impact.

Just personal experience - I'm not in a medical profession :)

Brightdreamer
12-07-2017, 08:03 AM
My mother had a concussion from a stair fall some years ago, which didn't set in until some time later. She had terrible dizziness/vertigo for days, but no vomiting, and no bleeding from the bump on her head.

So it's possible to have a concussion without vomiting or without a bleeding head bump... and the symptoms of concussion can be delayed by hours.

If you just want her badly rattled, enough to make her stunned/disconnected for a while (but not actually concussed), you could probably do that, too; not all head bumps lead to drastic complications.

Tornadoboy
12-07-2017, 08:04 AM
I know from personal family experience that not all people vomit upon receiving a concussion. In fact, said person has never vomited, and they've had multiple concussions, both mild and severe.

As to the bleeding, I can't attest to that part. Would she have hit the window hard enough to crack it? In which case, she might be cut. Said person mentioned above was once in a car accident and actually slammed their head into the roof of the car. No bleeding. (Again, concussion) For that to work, though, you'd need to think about the angle of the accident and impact.

Just personal experience - I'm not in a medical profession :)

Note: I just edited and expanded my questions right as you replied, so I've got a few more questions now.

I'd rather not have her bleed or be seriously injured so having her smash the window with her head would probably be too suggestive of a really bad injury, so I want to avoid that if it's plausible. The car rolls a few times, though it's down a hill and not from momentum so it wouldn't be too violent, but having her head hit the roof would be plausible.

The mechanics of the crash is them sliding backwards down a steep hill during a severe blizzard, car rolling a few times, smashing off of trees until the car finally smashes her side into a particularly solid tree which caves in the passenger's back door behind her. She also ends up with a sprained shoulder on that side.


My mother had a concussion from a stair fall some years ago, which didn't set in until some time later. She had terrible dizziness/vertigo for days, but no vomiting, and no bleeding from the bump on her head.

So it's possible to have a concussion without vomiting or without a bleeding head bump... and the symptoms of concussion can be delayed by hours.

If you just want her badly rattled, enough to make her stunned/disconnected for a while (but not actually concussed), you could probably do that, too; not all head bumps lead to drastic complications.

I need her to pretty much be unaware, unable to stand, walk and pretty much have no understanding of what's going on for a while, in other words in a complete semi-conscious daze like she's almost asleep, again a couple hours would be convenient. Think "someone so drunk they can't stand, can only mumble incoherently and keeps passing out"

Kitkitdizzi
12-07-2017, 08:12 AM
This happened to me. I was t-boned in an intersection. I was doing a left turn (in a Ford Ranger) and an SUV ran the red light and hit the back of my truck at about 40-45 miles an hour, ripping the wheel off the rear axle. He rolled, his trailer detached and smashed the front of my truck, and I spun off into a signal post. Don't remember any of it, because my head hit the side window. I briefly came to, couldn't see well because my glasses fell off, and found people banging on my passenger-side window asking if I could open the door (I had manual locks and the light pole was pressed against the driver side door). I passed out again but apparently got the door open because the next thing I recall was being put on a gurney and rolled into the ambulance. Reading my accident report is kinda a hoot because I was apparently talking to the cop but had no idea where I was or what I was doing (except I said I needed lightbulbs) and I don't remember any our conversation. I couldn't tell the EMTs who was president or how old I was.

I was in the hospital for about 4 hours. In and out of it for most of triage and the CT scan. After a few hours I was pretty aware again and finally started feeling pain (that's when they gave me morphine). Was very dizzy when I tried to stand but didn't throw up until about 12 hours later (and that might have been from the pain meds).

In addition to a very tender head (I didn't bleed) I had seat belt burns on my neck and an epic bruise on my thigh from where it also apparently hit the door.

tiddlywinks
12-07-2017, 08:24 AM
Heh. Okay, let's see. Again, this is just from personal family experience, so take with grain of salt.


So here's my questions:

- I know vomiting is common for people with concussions but I'd rather not have her do that given the situation, so I was wondering if it is believable that she wouldn't vomit having been hit hard enough to do what I described above? Yep, as per my previous answer.

- Is it believable to have her not bleed if she hit her head that hard? You mention in your followup response that the car rolls a couple of times. Not sure how easy it would be to walk away from that without scraping up a bit there, but I could see it, maybe? As to the head injury itself, that I could believe. I've also seen a concussion from smacking one's head against a cement pillar, crashing into the pavement, etc. and no bleeding. (*sigh* don't ask)

- Is it believable that she more or less could mostly return to normal within say 8 to 10 hours, sleeping a good portion of that time? Depends on how bad the concussion is, when it sets in, etc. If she rests her brain -- meaning avoiding tv, music, computer, anything that would tax her mental faculties -- It also might depend on whether she's had a concussion before. General rule of thumb seems to be a couple of days before you're really back to 'normal', though you may continue to experience side effects for longer like fuzzy thinking, being extra tired, headaches, concentration problems, noise sensitivity, etc. From personal experience, I'd still question her judgement and ability to fully function any less than 24 hours after. And if you actually have her lose consciousness, that could imply a more severe injury.

- What's the story with keeping people awake with concussions? I know they used to tell you not to let the person sleep, but isn't that just so as to watch for symptoms a serious brain injury? My male protag knows he's not in a position to do anything for her if she does have a serious problem, and I'm thinking of his logic being that if she was going to die from say a brain bleed or something that he'd rather it happen in her sleep. Again, don't quote me because not doctor, but it's to monitor the person for signs of a more serious brain injury. If they show more severe symptoms (repeated vomiting, dilated pupils, trouble walking, can't carry a conversation), that could be a sign they've suffered more severe trauma. Otherwise, rest is okay and recommended. Not much you can do other than rest, both physically and mentally.

Hope this helps.

ETA: Cross posted with KitKit - my personal family crash dummy was also t-boned and hit the roof of the car. Like Kitkit, they were babbling a storm and pretty out of it when pulled out of the car. Memories are pretty sketchy for that entire time period. Unfortunately, they ended up with post concussion syndrome, which is why I can't really answer your recovery time. But I fell on the ice last year and smacked my head on the pavement - ended up with a 'light' concussion and it was still about 3 days until I was back to normal.

Tornadoboy
12-07-2017, 08:28 AM
Hope this helps.

Most definitely, thanks!

As far as being scraped up that wouldn't be a problem, I just don't want her severely injured or bleeding heavily. I want her to be able to function again within a day, but the occasional brief spell of dizziness and vertigo wouldn't get in the way. The whole point of this part of the story is forcing two people who normally don't particularly care for each other to have to re-evaluate their opinions and develop a friendship.

Kitkitdizzi
12-07-2017, 08:46 AM
ETA: Cross posted with KitKit - my personal family crash dummy was also t-boned and hit the roof of the car. Like Kitkit, they were babbling a storm and pretty out of it when pulled out of the car. Memories are pretty sketchy for that entire time period. Unfortunately, they ended up with post concussion syndrome, which is why I can't really answer your recovery time. But I fell on the ice last year and smacked my head on the pavement - ended up with a 'light' concussion and it was still about 3 days until I was back to normal.

Ahem. Kitkit does not babble.

I did have post concussion syndrome too. I could function the day after, but I was in a lot of pain. After that I had chronic headaches and was on Nortriptyline for about two years. I also had muscle spasm and cramping issues in my neck, shoulders, and upper back as my top two vertebrae were pushed forward out of alignment with my spine. About a year-and-a-half of physically therapy to get over most of that.

The guy who hit me also ended up at the same hospital and ended up in the same room as me. We were curtained off from each other but I could hear him complaining to a friend that his head hurt because he hit the roof when the car rolled. Guy was lucky I couldn't figure out where the floor was to go over there and give him a piece of my mind.

tiddlywinks
12-07-2017, 08:52 AM
Ahem. Kitkit does not babble.

Mm-hmm.

*cough* ask her about the pitcher of Margaritas *cough*

Kitkitdizzi
12-07-2017, 10:47 AM
Mm-hmm.

*cough* ask her about the pitcher of Margaritas *cough*
Hey! That was my alter-ego, Tequila. I don't let her out much.
And I thought what happens in San Francisco stays in San Francisco.

Sorry, OP. This is what happens when Winks and I end up on the same thread.

cornflake
12-07-2017, 10:57 AM
I've got a female protag whom I need to be knocked out or at least completely dazed and only semi-conscious for about an hour or two, she bangs her head off her car door's window during a crash and is left with a knot above her ear. I don't want her too badly injured, but for the story I need this to happen.

So here's my questions:

- I know vomiting is common for people with concussions but I'd rather not have her do that given the situation, so I was wondering if it is believable that she wouldn't vomit having been hit hard enough to do what I described above?

- Is it believable to have her not bleed if she hit her head that hard?

Those are immaterial -- bleeding occurs if you break blood vessels and/or the skin, has nothing to do with a closed head injury. The first q. is individual. Your larger problem is knocking someone out for AN HOUR OR TWO. That's likely a serious head injury. Someone was unconscious for an hour after a closed head injury I'd assume they're going to end up in ICU if they're lucky. If they're dazed for a couple of hours, that's not a concussion you're walking away from feeling fine either. You're going to be a good mess for a good while

- Is it believable that she more or less could mostly return to normal within say 8 to 10 hours, sleeping a good portion of that time?

No. Concussions don't disappear. You're talking about what sounds like a severe head injury though, so I dunno what to tell you but even a mild concussion might leave someone feeling ok that day or the next, but will come back to bite them in the ass.

- What's the story with keeping people awake with concussions? I know they used to tell you not to let the person sleep, but isn't that just so as to watch for symptoms a serious brain injury? My male protag knows he's not in a position to do anything for her if she does have a serious problem, and I'm thinking of his logic being that if she was going to die from say a brain bleed or something that he'd rather it happen in her sleep.

You're meant to keep someone awake and/or wake them every couple of hours so that if they did suffer a more serious injury than was apparent, they don't slip into a coma or drop dead while asleep, because, say, they have a bleed that depresses respiration and basic function. Someone who was unconscious for an hour, or anything close, is in a hospital.

Debbie V
12-07-2017, 08:14 PM
My daughter had a very mild concussion this spring. No loss of consciousness or dizziness. We didn't even think she had a concussion until she woke up feeling woozy the next morning. She passed the neuro exam, but her symptoms were enough for it to be labelled a concussion by the pediatrician. Protocal was that she couldn't return to sports or anything else that might jar her brain until one week after the final symptom. She ended up missing a week and a half because she shook her head hard one day in class and then felt dizzy.

More severe concussions are treated by total rest. No visual stimulation, especially blue light. No TV, dark room, etc. So a return to fully normal is unlikely after such a short time.

heza
12-07-2017, 09:54 PM
Your larger problem is knocking someone out for AN HOUR OR TWO. That's likely a serious head injury. Someone was unconscious for an hour after a closed head injury I'd assume they're going to end up in ICU if they're lucky. If they're dazed for a couple of hours, that's not a concussion you're walking away from feeling fine either. You're going to be a good mess for a good while

This.

I never gave much thought to people getting knocked out in books or movies/tv shows until I had a concussion. Now, all I can think is, "OMG. That person needs a CT scan ASAP!" and I'm very skeptical that someone could be "out" for an hour or two and then just bounce back to normal. And I never really noticed before how often it happens. It ruined action movies for me.

For me, I had a light injury. I was playing in the floor with my dog, and she head butted me. The top of her head got me on the edge of one of my brow bones. I fell over, blacked out for a second, and the spot on my brow bone swelled up to just a little smaller than a ping pong ball. My husband rushed me to the ER. I was dizzy and had trouble walking a straight line and needed help.

The biggest problem was that I could not think. Like, how to open the door, how to get my seat belt on, where to go when we got to the ER. I was conscious and standing (mostly), but I was totally helpless. I couldn't have a conversation. The funny thing was, the doctor had me in the examining room and asked me what happened. I just looked at my husband, and he explained. Well, this set off warnings for the doctor, and he asked my husband to help the nurse with paperwork out at the desk. Then he asked me again. I could tell he wanted something from me, and I tried. I did. But it came out like, "Dog. And the... carpet. There was... I knee... I... with car and tea, so hand." And then he brought my husband back in and asked him to explain it again. Lol. I can remember most of what happened, but at the time, I couldn't make sense of it.

I had a CT scan to check for brain bleeds but didn't have any. They didn't make me stay awake for any specific amount of time or anything, but I had to have another scan two days later because bleeds can show up afterward. After a couple of hours I was doing better, making more sense and was more aware of my environment. I wasn't supposed to use my brain for a full week. I still have bouts of dizziness I think are related.


ETA: And I did not vomit. I did vomit and pass out briefly when I broke my ankle, though.

neandermagnon
12-07-2017, 10:47 PM
The England Rugby website has some good videos about concussion, i.e. causes, symptoms, red flags, recovery and returning to play after concussion. http://www.englandrugby.com/my-rugby/players/player-health/concussion-headcase/

I agree with everyone who said that being knocked out for an hour would be considered a serious medical emergency, and following a car accident would mean a trip in an ambulance or maybe even an air ambulance. It's possible they'd already be in the ICU or at least being seen by doctors (scans, etc, to check for brain bleeds and similar) by the time they come around. If there's a brain bleed (which is what doctors will be worried about and scanning for if someone's been unconscious for that long) then they'd have emergency surgery. After anything like that, the patient would be kept in hospital and not let home the same day. I don't know how long they'd have to stay in hospital for, but even without being unconscious for an entire hour, lots of head injury patients would be kept in overnight for observations. Patients with mild concussion are sent home the same day. Mild concussion often doesn't involve being knocked out at all, or it involves being knocked out only for a few moments.

blackcat777
12-08-2017, 12:13 AM
I hit my lip on a steering wheel in an accident going 35mph. I did not black out, no vomiting, thought I was fine.

Three days later, I suddenly had no use of numbers (I went to work, tried to ring a credit card and was like, "WTF, someone needs to drive me home"), and I knew what I wanted to say, but I'd say the wrong word starting with another letter. I was like that for six weeks. I couldn't be around lights, I physically couldn't keep my eyes focused on reading, and I slept CONSTANTLY. No driving.

I saw doctors and they basically told me to sit at home and do nothing. The only thing they could do for me was document that I saw them with complaints for insurance claims. I feel like a lot of people didn't take me seriously because I DIDN'T black out.

I had random crying spells for the following couple of months and felt emotionally flat for a long time. Weird hormonal changes I think were linked in part to spinal misalignment. Chiropractic ended up being the best thing ever, but I had to find that years later on my own.

Anyway, concussions are strange things. The effects don't have to manifest immediately. I was "basically normal" after about six weeks, like able to count pocket change, read, and say what I meant again. But depending on the nature of the accident, there can also be all sorts of long term weirdness to contend with, too. To this day, when I write, I often type a wrong but phonetically similar word, which I never used to do before.

tiddlywinks
12-08-2017, 01:34 AM
Good catch by cornflake on the “being out for an hour or two”. I missed that last night when responding. That’s bad news.

Also, not to get on a soapbox, but having someone be “fine” after several hours versus days, weeks, months...it trivializes the severity of a concussion. It’s head trauma. To the brain. It doesn’t just go away. Even if you have a mild one, there are symptoms that linger or that you may not realize you have until later. (And sometimes what may seem mild initially can result in post concussion syndrome...) If you aren’t as lucky, it can have lifelong implications.

MaeZe
12-08-2017, 03:18 AM
I've got a female protag whom I need to be knocked out or at least completely dazed and only semi-conscious for about an hour or two, she bangs her head off her car door's window during a crash and is left with a knot above her ear. I don't want her too badly injured, but for the story I need this to happen.

So here's my questions:

- I know vomiting is common for people with concussions but I'd rather not have her do that given the situation, so I was wondering if it is believable that she wouldn't vomit having been hit hard enough to do what I described above? Leave it out, your readers won't care.


- Is it believable to have her not bleed if she hit her head that hard?Yes.


- Is it believable that she more or less could mostly return to normal within say 8 to 10 hours, sleeping a good portion of that time? If she's going to be really out for more than a couple minutes, then it's going to take more than 24 hours to be back to normal.

And adding to what others said, being out for more than a few minutes is a very serious concussion.


- What's the story with keeping people awake with concussions? I know they used to tell you not to let the person sleep, but isn't that just so as to watch for symptoms a serious brain injury? My male protag knows he's not in a position to do anything for her if she does have a serious problem, and I'm thinking of his logic being that if she was going to die from say a brain bleed or something that he'd rather it happen in her sleep.You let people sleep. You check on them at regular intervals to make sure they are not going into a coma which would happen with internal head bleeding. If you can't wake the person up, that's bad. But it's not like an overdose where you actually do keep the person awake to stimulate them to breathe.

Tornadoboy
12-08-2017, 03:19 AM
Hmmmm... all interesting stuff, I've got to think long and hard of how I play all that out, it doesn't need to be absolutely perfect but I want it fairly realistic and believable.

They're on their own so getting her to an ER or any medical help for that matter is out of the question, though my male protag isn't stupid, under normal circumstances he wouldn't move her and immediately call an ambulance if it was possible, but regardless they're beyond help for a few days and leaving her in the car isn't a viable option.

Point of having her "out cold" is I don't want her involved in any decisions for a while including stuff involving her own person or even being able to walk on her own, there are reasons this works for the story, she's not a passive person normally but I want my MP suddenly thrown in charge of everything including her. But I don't actually need her totally unconscious per se, perhaps having her "dazed and confused" for a while would serve the same purpose, just as long as she's not able to really understand what's going on. And I don't need her perfectly back to normal after a few hours, just "back in the game" so to speak, able to understand what's going on and ask/answer questions, and for realism I can probably throw in the occasional dizzy spell or vertigo without it altering things too much. And hours later after sleeping (figure 5 or 6 hours) I'd like her to be even more with it, able to walk and participate in things, though my MP would rather she just stay laying down as again he's not an idiot and knows she shouldn't be standing up.

And I know what you mean about how ridiculous head injuries and being unconscious are often treated, like the cliche of "hit on the back of the head - out cold" cliche, as if such a blow couldn't cause serious injury or death, and the person always instantly pops awake like Michigan J Frog jumping up and dancing. You'd all love the book I'm reading now (title and author shall remain nameless), the female protag was completely out cold for like 12 hours and after maybe another 6 or so she's up violent attacking someone with full force.

Also here's a weird question: How would this effect having a post traumatic flashback? I was thinking of having her suffer one as she starts to regain her senses and have it be pretty scary for the MP, he thinks it's due to her head injury though it's really not. Again, you'd have to know the story to understand why I'd have her do that, it would help set some things in motion.

MaeZe
12-08-2017, 03:28 AM
... I never gave much thought to people getting knocked out in books or movies/tv shows until I had a concussion. Now, all I can think is, "OMG. That person needs a CT scan ASAP!" and I'm very skeptical that someone could be "out" for an hour or two and then just bounce back to normal. And I never really noticed before how often it happens. It ruined action movies for me.....Drives me crazy but no one around me seems to mind.

I hate movies where:

Women faint and are unconscious for some convenient amount of time. Bull shit, that does not happen. Even if you did faint seeing the scary giant gorilla (which is also doubtful), the minute you were supine you would wake up.

Men are punched and they become unconscious for some convenient amount of time. Nope, that doesn't happen either. I don't know if there is some ninja move where you can knock a person out but regardless the way being knocked out is portrayed in the movies is baloney.

:(

Cekrit
12-08-2017, 03:50 AM
I've had plenty of concussions from sports and nave never vomited so that's believable. 8-10 hour recovery time is not realistic and the character should NOT sleep, she might not wake up. I am ignorant to the science behind why they shouldn't sleep but whenever I got one as a kid I was advised to stay awake as late as possible until I essentially crashed or pull an all-night thing, and my mum would check on me through the night which for the most part was just poking her head in and realizing I was still up playing videogames(which i shouldn't have been doing either. ) Dizziness and not being fully back to myself would persist through the week, so your character will no way be in her tip top form less than 12 hours later.

It is possible to get knocked out without a concussion I believe. I don't imagine every fighter every KO'd has a concussion each time.

I'm with MaeZe- I hate how in movies a non-forceful chop to the neck knocks out an apprentice as the master rushes into battle, or a little bump knocks someone out and leaves them helpless.

I think an accident can knock someone out, or at least put them in a daze long enough to help your story.

You could also just make the recovery from the accident last the two hours you need by say, making her fall down a ditch with the car or off a small cliff and somehow surviving. The time it takes for her to get back to society might be better than starting her off with health concerns.

Also: the headaches through the week were terrible. I ended up getting enough concussions that I started to get chronic migraines and was put on a pretty heady medication for them. I'm talking mid sentence *blacks out* type effects. So be careful.

Tornadoboy
12-08-2017, 04:02 AM
l no way be in her tip top form less than 12 hours later.

That's not a problem, she has a full 24 hours she can be out of whack to one degree or another, though after a couple is when I want her to start pulling herself gradually back together and start participating in what's going on, any longer than that and it probably suggests far worse a head injury than I want to assign to her.


It is possible to get knockYou could also just make the recovery from the accident last the two hours you need by say, making her fall down a ditch with the car or off a small cliff and somehow surviving. The time it takes for her to get back to society might be better than starting her off with health concerns.

Nah, they're completely on their owns for like 3 days and she's with him the whole time, I've already got plausible reasons set up for that, it's just the taking her out of the decisions for a while is what I need to figure out without damaging her too much or bending the laws of medical science.

I also like how people trade punches back and forth in an orderly fashion when fighting in movies, and how gunshots to the shoulder are always "minor" injuries, and never cause permanent nerve, muscle or bone damage, fatal bleeding or send the bullet ricocheting somewhere critical like the heart or lungs.

Cekrit
12-08-2017, 04:10 AM
I also like how people trade punches back and forth in an orderly fashion when fighting in movies, and how gunshots to the shoulder are always "minor" injuries, and never cause permanent nerve, muscle or bone damage, fatal bleeding or send the bullet ricocheting somewhere critical like the heart or lungs.

Bullets only temporarily damage actors until they see their show's white mage. I just finished The Punisher, and this guy gets shot at least twice an episode and ends up walking out season standing perfectly fine in a god damned tailored suit.

cornflake
12-08-2017, 06:54 AM
That's not a problem, she has a full 24 hours she can be out of whack to one degree or another, though after a couple is when I want her to start pulling herself gradually back together and start participating in what's going on, any longer than that and it probably suggests far worse a head injury than I want to assign to her.


Nah, they're completely on their owns for like 3 days and she's with him the whole time, I've already got plausible reasons set up for that, it's just the taking her out of the decisions for a while is what I need to figure out without damaging her too much or bending the laws of medical science.

I also like how people trade punches back and forth in an orderly fashion when fighting in movies, and how gunshots to the shoulder are always "minor" injuries, and never cause permanent nerve, muscle or bone damage, fatal bleeding or send the bullet ricocheting somewhere critical like the heart or lungs.

If she's addled for an hour or two she's not getting herself back together in a couple of hours, or being out of whack for only 24, really.


Bullets only temporarily damage actors until they see their show's white mage. I just finished The Punisher, and this guy gets shot at least twice an episode and ends up walking out season standing perfectly fine in a god damned tailored suit.

What bugs me more is people getting shot and falling over, falling backwards, etc., as if bullets have that power. They do not.

If someone falls over after getting shot it's either a near-fatal wound that's causing an immediate dire injury (like a shot to the head or through the heart/lungs), or it's from the shock of being shot. Otherwise, save a monster bullet at super close range, and even then, you keep standing. In movies/on tv, people get shot and tip over like they were hit with a bat, or fly backwards as if it carried an immense force.

neandermagnon
12-10-2017, 05:26 PM
I've had plenty of concussions from sports and nave never vomited so that's believable. 8-10 hour recovery time is not realistic and the character should NOT sleep, she might not wake up. I am ignorant to the science behind why they shouldn't sleep but whenever I got one as a kid I was advised to stay awake as late as possible until I essentially crashed or pull an all-night thing, and my mum would check on me through the night which for the most part was just poking her head in and realizing I was still up playing videogames(which i shouldn't have been doing either. )

The advice from England Rugby (they have a lot of good info on concussion seeing as there's a risk of concussion from playing rugby) is that it's beneficial to sleep after a concussion and playing video games is a bad idea. Anything that requires intense attention/focus/thinking is a bad idea and avoiding screens is a good idea, just because the brain needs to rest so it can recover.

The reason it's advised that first aiders try to keep someone awake if they have a head injury is that if someone has a brain bleed (i.e. inside the skull) and they go to sleep, they're not actually going to sleep they're falling into a coma. If that happens they need medical treatment urgently or they'll die. If someone's already asleep, you won't notice that they've gone into a coma, hence not get life saving treatment in time. However, once someone's been checked out by medical professionals, they can be allowed to sleep but would require monitoring, i.e. someone checking up on them every hour or so check they can be awoken. If someone's kept in overnight for observation after a head injury, nurses will do this and will assess them for GCS* score. If it's a mild concussion and they're sent home they'll ask a family member to check this, however when my daughter got a concussion playing rugby they said it wasn't necessary to check on her every couple of hours, maybe it was every 4 hrs, can't remember. The NHS give you a card with what signs to watch for after a head injury and when to dial 999. If they think the person has that much risk that the head injury will get worse they won't be sent home in the first place.

*Glasgow coma scale - dunno if this is just used in the UK seeing as it has a UK place name, 3 = in a coma, 15 = fully conscious and being asleep doesn't make the score lower as long as they are sleeping normally and can be awakened.

Note re OP's question about vomiting: regarding vomiting - I was told by the A&E nurse that vomiting once is nothing to worry about. Vomiting repeatedly = dial 999.

Nausea (with or without vomiting) is a symptom of concussion but the exact symptoms you get is very individual and it's totally plausible to not get any nausea or vomiting. Repeated vomiting is a sign of bleeding in the brain (hence the advice to dial 999) so if someone is repeatedly vomiting from the head injury but then makes a full recovery a few hours later and no medical intervention, that would be implausible.



In case it's of any relevance to anyone's story, if someone has a severe head injury with bleeding inside the skull, it's common for them to have a lucid interval after the injury. They may or may not lose consciousness or have a low GCS score (partial consciousness) immediately after the injury, but they then have a period of being fully conscious or nearly fully conscious, and then later their condition declines rapidly and they go into a coma. The advice given for dealing with patients immediately after a head injury has to take this into account and that can be extremely hard to tell the difference between a mild/moderately concussed person returning to normal consciousness and someone with a severe head injury having a lucid interval, which is why they'll do x-rays and brain scans to check for bleeding in the brain. If brain scans aren't available and/or they're not going to be in hospital for a while they need to be extra vigilant about any sign the patient is deteriorating, and keeping the patient awake makes it easier to spot those signs.

Evelyn_Alexie
12-22-2017, 07:44 PM
Thank you for this thread! I love all these answers! I came to the Research forum looking for information on historical rifles and pistols for a manuscript I'm revising, but I got distracted by this thread since it's perfect for a shiny new story I'm roughing out.

So would this scenario be plausible? I don't want the reader to hurt themselves by falling off the chair from laughing at how ridiculous my story is:

1 - Woman hits her head in a car accident. Immediately after the accident, she dials 911 but can't recall her name when asked.
2 - She feels a bit nauseated and has some bleeding from a cut on her scalp.
3 - She starts to feel dizzy, eventually loses consciousness.
4 - She wakes up in the hospital. Can remember her name and other details about herself, except the last couple days of her life are a blank. Can't remember the accident or events leading up to it.
5 - Doctor releases her from the hospital that morning, but advises her not to drive or do anything physically strenuous for a few days. Wants her to come back for another scan the next week.

Do I hear the sound of laughter? :roll:

DrDoc
12-22-2017, 08:38 PM
Back in 1971 I had just bought my first VW Beetle, a used one from a friend. I had to work early the next day and it was very foggy. I drove down the 2 lane road rather slowly because I knew there was a 4-way intersection with a blinking yellow light (meant stop, look, then go if clear). What I did not know was that the storm of the previous night had broken a branch of a large oak tree and that branch was now preventing me from seeing the blinking yellow light. I just kept creeping along and the next thing I saw was the word Mushroom on the side of a tractor trailer (I was in mushroom growing country in SE pennsylvania), then everything went dark. I was thrown out the window of my new used VW Beetle and slammed into a telephone pole. The ambulance came and I woke up in the ambulance. As a former medic in Nam I started giving the EMT instructions on what to do. I am uncertain how long I was out, but it was long enough to call an ambulance and come get me in a rural part of Pennsylvania. I felt cold on waking up, but was not really aware of much until after I was seen by the physician. I had no observable physical injuries, not even a bruise. They observed me for a few hours and then I was released and I went off to work with my parents driving me. My new used Beetle was crushed by the rear wheels of the trailer and totaled, and I haven't owned a Beetle since. My whole life I have wanted a Beetle.

Evelyn_Alexie
12-22-2017, 09:37 PM
Yikes! I'm glad that story had a happy ending. (Well, sorta happy. It is too bad about the Beetle.)
So maybe my scenario isn't too implausible.

MDSchafer
12-22-2017, 10:04 PM
- What's the story with keeping people awake with concussions? I know they used to tell you not to let the person sleep, but isn't that just so as to watch for symptoms a serious brain injury? My male protag knows he's not in a position to do anything for her if she does have a serious problem, and I'm thinking of his logic being that if she was going to die from say a brain bleed or something that he'd rather it happen in her sleep.

You don't need to keep people awake with a concussion so long when they are awake they are able to hold a conversation, don't have dilated pupils, have good balance and haven't vomited recently. Sleep is good for a concussion. That said, if it were my family member or close friend I would make sure they didn't drive and I'd wake them up every two hours and have them tell me their name, date of birth and location, cause I'm a just paranoid enough to be a good nurse.

As far as developing a brain bleed several hours after a concussion? It's rare, but it happens.

Your male protag could just use google, and see there's no problem with sleeping after a concussion.

One of my favorite M.A.S.H episodes deals with this where Hawkeye has a concussion, is trapped with some Korean villagers and he says he knows that you can go to sleep with with a concussions, but is afraid that he can't trust that information because he has a concussion, and so he keeps talking in an effort to keep himself awake. It's a brilliant piece of television.

MDSchafer
12-22-2017, 10:10 PM
I've got a female protag whom I need to be knocked out or at least completely dazed and only semi-conscious for about an hour or two.

https://memegenerator.net/img/instances/63149021.jpg

Tornadoboy
12-23-2017, 11:33 PM
Again thanks for the help everybody! It's all been VERY useful!

I'm thinking at this point to not have her really knocked out at all, just very dazed. She also went through an emotional hell right before (and I mean REALLY bad, reliving something truly horrible) and was in the midst of a semi-meltdown at the time of the crash, so between that and the accident itself I think it's plausible she's simply overwhelmed by everything, that would render her kind of a complete wreck for a little while even if she wasn't neurologically unconscious. I kind of like the idea of the male protag sort of entering new territory with his understanding of her as a person and her vulnerabilities, this is not something he would have expected from her at all, but it's completely believable when he knows the whole story later.

blacbird
12-24-2017, 03:21 AM
Having experienced a couple of concussions, and having read a lot about sports injuries of this sort, I can provide some perhaps useful details.

Detail No. 1 is that every "concussion" is an individual event. The symptoms and consequences of each one are not entirely predictable, or even diagnosable at the time of injury. Many of the consequences don't manifest themselves until much later.

My most recent incident of this sort happened several years ago. I slipped on black ice in the parking lot of my local grocery store, at night, while carrying two large bags of goods in my hands. Direclty backward, no chance of catching myself, landed on my shoulders and the back of my head. I never lost consciousness, but I literally could not move for maybe half a minute. A bystander saw this happen and rushed over to help me, and asked me questions, and I could not respond. It was, I suspect, much like a lot of boxer's knockouts. The ref could have counted to fifty or more, and I would have heard every number.

After about half a minute I managed to struggle to a sitting position and was able to respond verbally. He helped me to my feet, and I leaned against my car for a minute or so, while he collected the goods that had been scattered across the parking lot in the fall. I think he was about ready to go get medical help when I convinced him that I was okay, thanked him profusely, and could drive home, which wasn't very far away. In retrospect, that was probably a bad idea; I should have had somebody look me over. I did get home, but had a significant bleeding cut and swelling on the back of my head, which alarmed my wife considerably. I went directly to bed, and was both dizzy and slightly nauseous (although I didn't vomit).

For the next three or four days I was unusually sleepy and lacking in energy. Stairs were a bit of a challenge, especially going down. Eventually it cleared up, and I never did see any medical people about this incident, but I doubt I would have passed an NFL concussion protocol, unless I played for the Seattle Seahawks.

A pro sports incident that has always kind of haunted me happened in Major League Baseball five or six years ago. A really fine player named Justin Morneau, who had won a Most Valuable Player award a couple of years earlier while playing for the Minnesota Twins, was struck in the head by a defensive player's knee while attempting a slide into second base, on a routine infield grounder play. I've seen the replay of that incident numerous times. It didn't look like much, and certainly wasn't intentional. But Morneau missed more than a year of playing time, in the central portion of what should have been his most productive years, because of concussion symptoms. You don't want to stand at the plate and face 98-mile-an-hour fastballs if you can't focus your eyes and feel like you're about to fall down. Morneau never recovered his all-star abilities.

And, of course, we now know the effects of multiple concussions are cumulative. Stories of punch-drunk boxers who can't enunciate clearly are legendary. Medical evidence of severe brain deterioration in NFL and HHL players is well-documented. Some of these players have, tragically, known about this. The great NFL linebacker Junior Seau, who had a really good gig announcing and starring in feature shows after his playing career ended, shot himself in the heart, so he dould donate his brain to the medical people for study of the syndrome.

Concussions are serious injuries, and every one is its own thing. So, for your writing purposes, you have leeway to make your concussion have whatever effects you need. But they are significant injuries, in any event.

caw