Parent Thread

Gavinmad said:

It's just important to remind people (imo) that concussion is a somewhat understated word for what is a TRAUMATIC BRAIN INJURY.

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Should we MRI every one with a concussion? I donno, Hosix is a smart guy, probably got the kid checked before you could say Diffuse Axonal Injury 10 times. It's a parent thing, I guess.

Izo said:

Should we MRI every one with a concussion?

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Feel like you're trying to set me up here, but that decision would be up to the doctor that everyone who is suspected of a concussion should see, not me.

sleevedraw said:

*screams in utilization management nurse*

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*laughs in physician billing hours*

Gavinmad said:

Feel like you're trying to set me up here, but that decision would be up to the doctor that everyone who is suspected of a concussion should see, not me.

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Indeed. I'm sure Hosix took the kid for a checkup. If not, we don't do shit >24h if no neurological defficits / commotio symptoms. If they're there, the symptoms, and one doesn't take the kid for a checkup, well, it's darwin awards I guess.

sleevedraw said:

Answer to the question is generally no unless the patient has some kind of neurological deficit. See clinical indications ---> trauma.

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But I never said anything about MRIs in the first place. I simply said that concussion is a misleading word that tends to gloss over what a concussion actually is, a traumatic brain injury, which is why anyone suspected of a concussion should be seen by a doctor/qualified medical professional.

Izo said:

Indeed. I'm sure Hosix took the kid for a checkup. If not, we don't do shit >24h if no neurological defficits / commotio symptoms. If they're there, the symptoms, and one doesn't take the kid for a checkup, well, it's darwin awards I guess.

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Ya with those symptoms he went to urgent care with his mom the next day. I’d rather him be cleared by a DR than some coach.

Gavinmad said:

But I never said anything about MRIs in the first place. I simply said that concussion is a misleading word that tends to gloss over what a concussion actually is, a traumatic brain injury, which is why anyone suspected of a concussion should be seen by a doctor/qualified medical professional.

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Obviously. I'd hope most people, let alone parents, know this. I mean, how does one get through life not knowing about it? You scare me, Gavinmad - I'm a medical professional MRI requests are simply the next level, when laymen start diagnosing. Neurons heal or they don't, DAI etc. Significant ICH causes neurological defficits. A tiny fraction needs surgery, ICP relief. Everyone else is observation 24h, parents care or hospital. Pt. Needs minimal physical strain, sleep if possible (no waking up every hour folktale 'fact'). Every ER has a guide for this here. We do CT/MRI if we suspect anything or if PE comes up with pos findings, admit in ER / neurosurgery observation units. I'm sure it's standard in your end of the globe too

Izo said:

Obviously. I'd hope most people, let alone parents, know this. I mean, how does one get through life not knowing about it? You scare me, Gavinmad - I'm a medical professional MRI requests are simply the next level, when laymen start diagnosing. Neurons heal or they don't, DAI etc. Significant ICH causes neurological defficits. A tiny fraction needs surgery, ICP relief. Everyone else is observation 24h, parents care or hospital. Pt. Needs minimal physical strain, sleep if possible (no waking up every hour folktale 'fact'). Every ER has a guide for this here. We do CT/MRI if we suspect anything or if PE comes up with pos findings, admit in ER / neurosurgery observation units. I'm sure it's standard in your end of the globe too

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So is it not a big deal that Hosix' son didn't go to a doctor until the next day? Cause I assume if that really rare 'worse than just a concussion' scenario happens, it would be much more dangerous if you weren't immediately seen by a doctor.

Gavinmad said:

So is it not a big deal that Hosix' son didn't go to a doctor until the next day? Cause I assume if that really rare 'worse than just a concussion' scenario happens, it would be much more dangerous if you weren't immediately seen by a doctor.

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Depends on the symptoms. We don't admit everyone with a concussion, no, especially not if no symptoms. If the symptoms manifest later, his kid might have been seent home the first time visit with warning/acto on instructions. In essense, if it's worse than a concussion, there are symptoms - parents can tell if you're lethargic, vomits, unconscious, shuns light, symtoms return after a period of remission, etc etc.

A concussion is bascially the result of over-stretching neurons. It takes time for the tissue to heal. Complications such as bleeding is what we look for as well. Arterial will manifest in minutes, hours. Venous bleeding later. It's extremely rare to have bleeding symptoms past 24h. Treatable both by ICP relief, bore or other brain surgery techniques. It's mostly the effects of the stretching, swelling around the neurons that manifests over hours, betters over weeks. Hopefully no DAI.

TLDR; it's fine to have a doc look when symptoms manifest, even if not seen at initial hit. We're treating a patient, not a clock. Also we don't heal the injury be seeing the pt. We diagnose it, PE including BP+p etc, the rare scan, bloodworks, prescribe pain killers/rest/lean regime, and admit if symptoms/noone to look for pt at home. So the speed of the symptoms as well as the mechanics of the injury, if any, is a good indicator of whether you 'need to be seen by a doc'. Parents usually don't need instructions for this, intuitively know if their kid is neurologically not themselves. I can't say how much of an impact your system of law suits has on the above, but that's the general consensus. I'm fairly certain that EM docs are exempt / semi protected. Otherwise no doc would ever want to see you in the ER. Cheers, Gavinmad , you really should make some mini-gavs. You have great instincts. I hope it makes sense. Post Leffe brain atm, need to rehydrate.

Cad said:

My understanding is an MRI can't rule out or confirm a concussion in any case so you'd be looking for a bleed or some other issue. The MRI doesn't help with the concussion diagnosis at all, was what I was told.

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Bingo. The PE + mechanism of injury / anamnesis, makes concussion a clinical diagnosis. An MRI takes time, is expensive, and is very protocol dependent. The diffuse axonal injuries which MRI is very good for are often seen later, often with crescendo in symptoms, so it's not as useful in the acute scenario, mostly. Depends on PE findings. CT-C is fast, good for bleeds, usually the route of choice, if a bleed is suspected, but it is radiation. So, a protocol for actions taken is used in the ER, to balance the risks of imaging vs risk of injury. Observation for a period in the first 24h, rest, minimal physical stress is often the way to go.

Izo said:

Observation for a period in the first 24h, rest, minimal physical stress is often the way to go.

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It’s what we did. He is back up and playing. Has the week off before games start again. All systems are a go!

So my company is rebuilding most of our HQ and the architect and his brother (also involved) have been going in and out weekly for over two years now.

This weekend the architect's brother lost his youngest kid, not even half a year old or so, and it's fucking horrible. I don't know the circumstances. I don't even know the guy other than meeting him maybe five times (I'm not very involved with the whole thing).

I'm the saltiest asshole mother fucker in the world but when someone's kid dies I'm a puddle of tears.

Ronaan said:

So my company is rebuilding most of our HQ and the architect and his brother (also involved) have been going in and out weekly for over two years now.

This weekend the architect's brother lost his youngest kid, not even half a year old or so, and it's fucking horrible. I don't know the circumstances. I don't even know the guy other than meeting him maybe five times (I'm not very involved with the whole thing).

I'm the saltiest asshole mother fucker in the world but when someone's kid dies I'm a puddle of tears.

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Losing a child is beyond horrible. I can’t imagine the pain that comes with that.