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Concussion thread:
Yesterday I suffered my first concussion while skiing. I’m a GP and former rugby team doctor so I have done plenty of sideline and delayed concussion assessments in my time. This is a thread on what I’ve learned in the last 24 hours. 1/?
Yesterday I suffered my first concussion while skiing. I’m a GP and former rugby team doctor so I have done plenty of sideline and delayed concussion assessments in my time. This is a thread on what I’ve learned in the last 24 hours. 1/?
Wear a helmet. I impacted the bottom of a little gully headfirst at approximately 50km/hr (according to movement data I tracked). If I had been helmet free (which I had seriously considered as I wasn’t planning on doing anything “risky”) I would not be here to tweet today.2/?
Concussion is acutely very disconcerting to the affected individual. I don’t know how many times I looked around to try and work out where I was and how I had got there but my brain just couldn’t compute.3/?
The only thing that helped in the immediate aftermath was closing my eyes to keep the visual stimulation (and hence the brain processing requirements) down.4/?
I now I have full recollection of that whole day leading up to the accident including tipping into the unexpected Gully. However I temporarily lost that whole morning for around 15-30 minutes following the accident (retrograde amnesia). 5/?
Asking what I had for breakfast was a *very* good question in the original assessment. I had no freaking idea. Even arguing with my wife when she said I had porridge. “I don’t have porridge for breakfast!” 6/?
At the time I remember telling people that I was just dazed but the reality is I was probably knocked out for some seconds. You are right to not trust the patient’s word with an unwitnessed event. 7/?
GPS data shows that I “wandered” a bit after coming round. Where my wife found me when she arrived on the scene was up the other side of the gully. I had obviously started going up the wrong side to get out. A good warning sign of concussion. 8/?
I proceeded to put my own skis on and skied to the bottom with her chasing after me. I have absolutely no recollection of this at all, even now (anterograde amnesia). Ski patrol had been called but we got to them first and she made sure I was assessed there and then. 9/?
This is when I was asked about breakfast (and got it completely wrong). Also struggled to work out which ski field I was at. My head said the answer was Remarkables but it just didn’t seem right. Like it seemed unfamiliar. 10/?
I completely flunked the original neurological assessment under the doctor at the medical hut. My three item recall was originally 0/3 improving to 2 out of 3 after five minutes or so. 11/?
I had several other injuries, nothing major, but concussion is a major distracting injury. I struggled to explain what else hurt initially though it progressively became clear as time went on. 12/?
As a concussion assessor the thing that made me relax as I self-analysed my way through the whole process was the smooth return of my faculties in a steady and progressive fashion. Little repeat assessments with patients are useful in this regard. 13/?
Today I feel like I’ve been hit by a bus but that is all of the physical injuries talking. My head feels fine and with rest and gradually increasing my workload (physical, mental, emotional) I will test for any post-concussive effects. 14/?
The Remarkables medical staff at the ski field were amazing. Sympathetic, caring, yet firm with me. While I was there another more significant multi trauma came in. The staff continued to do short micro assessments with me as I continued to improve. 15/?
And finally
WEAR A HELMET!
That is all. /fin
WEAR A HELMET!That is all. /fin
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