The majority of the population has never experienced a concussion or has never been knocked out.  If you have never experienced a concussion, this is a summary of the main symptoms, from the patient’s point of view.  This is in the hopes that this information for family and friends and care givers that have never experienced a concussion will know what to look for and how to care for an individual who has been knocked out or has a concussion.

First, let’s describe what a concussion is.  A concussion is described or defined as a head trauma, an induced alteration of the mental status, which may or may not involve a loss of consciousness.  Concussions are graded into 3 categories.  Definition, treatment, and recommendations are different for each category.  The following is according to the American Academy of Neurology, which are the foremost authority and also the newest evaluation of concussions that are present in the medical field today and the standard for Extreme Sports Medicine Teams.

Grade 1 concussion is defined as a transient confusion, no loss of consciousness, and a duration mental status abnormalities under15 minutes.

Management is a caregiver or a loving spouse.  The athlete should be removed from sporting activity and examined immediately and at 5-minute intervals, and allowed to return that day to the sporting activity only if the post concussive symptoms resolve within 15 minutes.  Any athlete who incurs a second Grade 1 concussion on the same day should be removed from the sporting activity until asymptotic for 1 week.

Grade 2 concussion, which is worse, and the definition is transient confusion, no loss of consciousness, and a duration of mental status abnormalities of 15 minutes or longer.

Let’s take a moment to look at mental status.  Confusion may be as simple as they get up and they are walking the wrong direction.  They may not remember where they are or what field they are on or what arena that they are in or what town they are in, or even what day it is.  Simple questions should be asked.  How old are you?  What is your name?  Who’s the president of the United States?  Not only is it an evaluation of mental status but it is also very important to visually watch the individual.  Are they acting abnormally?  Are they doing things that they don’t normally do” For example, I had one cowboy that took his pants off and put his chaps on without his pants but he swore that he was all right.  Little things are important to watch.

Let’s go back to a Grade 2 concussion and management of it since the abnormalities last more than 15 minutes or longer.  The athlete should be removed from the sporting activity and examined frequently to assess the evolution of symptoms, with more extensive diagnostic evaluation if the symptoms worsen or persist longer than 1 week.  An athlete should return to the sports activity only after a being asymptomatic for 1 full week.

So let’s reiterate on a Grade 2 concussion right now.  The Symptoms should last no longer than a week and then an additional week should follow that they have no symptoms.  A Grade 2 concussion warrants that an individual who is a competitor or athlete should not participate in activities for two full weeks.  In addition to that, any athlete who incurs a Grade 2 concussion subsequent to a Grade 1 concussion on the same day should be removed from sports activities until asymptomatic for 2 weeks.  So the worse case scenario of a Grade 2 concussion, the competitor or the athlete should not participate for 3 weeks if they have multiple syndrome.

Grade 3, which is the worst type of concussion. Loss of consciousness, either brief or seconds, it may even be minutes or longer.  The athlete or competitor should be removed from the sporting activity for 1 full week without symptoms if the loss of consciousness is brief, or for 2 full weeks without symptoms if the loss of consciousness is prolonged.  Prolonged is usually longer than a few seconds, maybe extending into the few minutes category.  If still unconscious or if abnormal neurological signs are present at the time of initial evaluation, by a professional healthcare provider, the athlete should be transported by ambulances to the nearest trauma hospital.  If the athlete that has suffered a second Grade 3 concussion should be removed from the sports activity until asymptomatic for 1 month. Any athlete with an abnormality on CT or MRI brain scan consistent with brain swelling, confusion, or other intracranial pathology should be removed from sports activities for the season and discouraged from future return to participation in contact sports.

These standards are put forth by the American Academy of Neurology in 1997. They are guidelines that most healthcare professionals use today.

My personal recommendations over the years of experience with head traumas and professional athletes that have been knocked out would be that it is important that a family member or loved one look on and take care of this individual beyond being asymptomatic.  You may be able to do your multiplication tables and know where you are at and who the president of the United States is.  It doesn’t necessary mean that it is safe to let this individual drive a car or motorcycle or ride a horse.  Timing and balance may be altered just enough that the patient could become re-injured very easily.  I know this from personal experience of having concussions or being knocked out myself and also dealing with professional bull riders and professional rodeo contestants as well as other professional athletes.

I don’t believe that you will find an individual that has been knocked out or suffered at least a Grade 2 concussion who will disagree with the fact that things are a little weird for a week.

So take care of your loved one or your riding partner or your spouse.  Keep an eye on them.  Don’t let them drive.  A lot of tender loving care, and they will come out of it, but always seek a healthcare professionals opinion and guidance through either the Sports Medicine Team or nearest emergency room physician.