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When to Go to the Hospital

Comments [49]

Jeffrey Bazarian, MD, BrainLine

 

People like Natasha Richardson and others who've just had their brains jostled may be in no condition to decide if they need medical care. And the people around them may not know that hitting your head can be dangerous even if you don't lose consciousness. How do you know when you should go to the hospital after having "your bell rung"?

 

Going to the hospital after a head injury can mean the difference between life and death. But how do you know when to go? This can seem like a difficult decision, but let me sum up the answer for you: when in doubt, go to the hospital. Not later. Not tomorrow. Now!

Here's why.

The hospital is the only place that has a CAT scanner that can "look" inside your head and determine if there is any bleeding in your brain. Bleeding in the brain can be life-threatening when there is enough blood in the right spot to press down on the brain and squeeze it. These dangerous forms of bleeding are called epidural and subdural hematomas. Because the brain is trapped inside the skull, slow bleeding can force important parts of the brain against the inside of the skull and through the small hole in the base of the skull called the foramen magnum. These important brain areas, which control breathing and heart rate, stop working when they get squeezed and this is what results in death. With a CAT scan, epidural and subdural hematomas are easily diagnosed. The treatment requires surgery to remove the blood clot. The quicker the surgery, the better the chances for a good outcome.

So, how do you know when to go to the hospital? The decision is easy if you're the one making it for someone else and that person is not responding to you or looks asleep. This is called coma. The risk of a subdural or epidural hematoma in comatose head injured patients is high and you should summon an ambulance immediately!

But what if the head injury doesn't cause a coma? What if the head injury just causes a brief loss of consciousness, brief period of amnesia, or a sensation of feeling dazed? A person who has such an injury — termed concussion or mild traumatic brain injury — can look, and even feel, just fine. The problem is, even though the person looks good on the outside, inside the skull there is a small chance that slow bleeding is taking place. After a concussion, the chances of this happening are not large — about 1 in 1000 — but the only way to diagnose it is with that hospital-based CAT scan.

Here are the symptoms of a concussion that should prompt an immediate trip to the hospital or emergency department.

  • Loss of consciousness, even if only briefly
  • Any period of amnesia, or loss of memory for the event
  • Feeling dazed or confused
  • Headache
  • Vomiting
  • Seizure
  • In addition, for children under 2 years of age, any scalp swelling or abnormality in the way they usually behave.

One word of caution: because any brain injury — even a concussion — has the potential to injure the brain, the brain-injured patient may lack the judgment to make an informed decision regarding whether or not to go to the hospital. Family and friends can be instrumental in helping the patient chose a course of action that is best for him or her. And when in doubt, go to the hospital!

 

Click here to go to About Ask the Expert.

Jeffrey Bazarian, MDJeffrey Bazarian, MD, Dr. Bazarian is an emergency physician with a strong research interest in traumatic brain injury. He is associate professor of Emergency Medicine, Neurology, and Neurosurgery at the Center for Neural Development and Disease, University of Rochester Medical Center.


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Comments [49]

I was hit in the soft part of my head at the base of the back of my head last nite. I got sick last nite and today I have a splitting headache and nausea. The hit was significant enough that I almost was knocked unconscious. Should I go to the hospital?

Nov 23rd, 2014 9:13am

I was cleaning my room and a glass lamp fell and hit me on the top of my head...i wasnt worried at first but now i am a little

Nov 19th, 2014 11:55pm

I got hit in the head with a 75 pound weight, and my head bled for about a half hour then I have had a continued head ach that hurts, should I be concerned?

Nov 10th, 2014 2:09pm

I was skateboarding on a wooden ramp and my wheel got caught at the bottom so I fell forwards and hit my head, my eyes feel a bit heavy but no headache, what do I do?

Nov 8th, 2014 11:06pm

I was reaching into my car to grab my phone from my cup holder. On the way out of the car, I thumped the back of my head on the frame of the opening to the drivers seat. I should be honest; it was not a hard hit, but a mild thump to the lower back part of the head. Initially, I decided that it was not that hard of a hit and I should just monitor it through the day. However, as I started researching the subject online I began to believe that I should rush to the ER despite not exhibiting almost any of the symptoms of a mild or severe brain injury. I decided not to go the the ER as of now, but I will continue to monitor my condition for the next couple of days. The only issue preventing my from going to the ER is the fact that I am 28 and already have had a CT scan and Nuclear stress test and multiple chest X-rays. I just don't want to increase my chance of developing cancer down the road from so many x rays. 

Nov 8th, 2014 12:58am

I hit my head with the corner of my bathroom vanity.  Should I be worried?

Nov 2nd, 2014 11:33am

Last week ,My head hit on the cement and I went black for about 10 seconds and I feel nauseated at the same time. What could be the Possibilities in that Head Injury? Huhu I'm little worried I wasn't able to go to hospital for check up due to lack of Money. Please Help me. :( God Bless.

Oct 31st, 2014 6:57am

I have back pain which makes me fall. I got up from sofa feel to the floor and hit my head I work with my hubby standing over me I feel dizzy sore head bit confused. He took me to bed should I worry feel so weird

Oct 29th, 2014 10:21am

at the show Thursday I was on a ride and hit my head on the metal bars and it bled, it has been 4 days and I still am getting quite bad headaches and feel like vomiting, should I be concerned?

Oct 26th, 2014 7:26am

On the 14th of Feb 2010 I was in a RTC I got a bleed on my brain I was past out when help got to me I was only given hours to live after the Op on the brain. Could or would I be at risk of ever getting a other bleed on the brain now?

Oct 17th, 2014 8:13pm

I had a sickness bug Monday night and passed out into the bath, I was out for about a min before my husband brought me round, I have a bruise at the back of my head and some pain, but now 2days on I am getting some vertigo symptoms, should I go to my doctor or straight to hospital?

Sep 24th, 2014 2:17pm

A small bump on your head isn't that serious.I bumped my head hard a while ago but I'm fine just feel a little sting/pain.

Sep 17th, 2014 8:34pm

A locker hit my head and i felt like it was bleeding (but it felt from the inside).... Now it hurts even if you touch it and all my hair has become dead in that area! Please help!

Sep 14th, 2014 11:20am

I hit my head on my face just this morning and it hurt like hell but I'm okay, so far, nothing else but the pain of hitting my head and the big knot on my head.

Sep 8th, 2014 9:13am

I was riding my bike. really fast down the hill and I stood. up and then let go of the handle bars and the bike started to walble down the st and I went to grab it and I fell hit my head really hard and got up and went home my head was throbbing and when I got home I started to feel dizzy and. and I have a bad headache,I kind acted like a 5 year old and I was all emotional should I go to the hospitals?

Sep 7th, 2014 12:30am

Today as i was slamming the back hatch of my car shut, i accidentally slammed it on my head about 1 inch from my hair line (right on top of my head.) It hurt so bad, and when i looked in the mirror, i noticed a couple cuts from it and that my head was bleeding. It has been a couple hours and i have a headache and a jaw ache, and my wound still hurts pretty bad. I dont really feel dizzy, but can definitely feel that i was bashed in the head...Should i go to the hospital?

Aug 27th, 2014 6:19pm

Today, I have hit my head quite hard on the corner of my radiator. A bump started to form, and hurts when something touches it; even the slightest thing. I haven't had any signs of vomiting; although, last night i was literally sick (probably an ordinary bug). Also, a tiny bit of dizziness going on, but seems fine. I just want to know if this is going to be OK. I will be completely grateful if you could give me an answer, thank-you!:-)

Aug 12th, 2014 6:35pm

If you hit your head, are hit or fall go to hospital & get checked or see a Gp ( I am in London Uk) to get it checked out & recorded and keep a log. You can develop post concussion syndrome or traumatic brain injury which I now have after 2/3 knocks to brain. Join the pcs group on facebook or set one up, look up bloggers, I find helpful, I tripped on a cloth & hit my head at a clients but thought nothing of it. Few weeks later cat knocked stereo on my head. Felt very ill since. In UK- NO treatment!! Thankfully am a yoga therapist & mindfulness teacher/therapist so def recommend that- mindful breathing, but this is awful. Am using lavender oil all over my head with water which helps, lavender baths, & will try acupuncture. Wish you well recovering. Take care blessings & namaste Nathalie

Jul 23rd, 2014 7:22am

patting a pet sheep .and he got aggressive and hit butted a steel gate and also hit the top of my head and theres a bump..my head feels weird ..but im also on antideppressonts and its been 3 days after iv hit my head and its still hurting

Jul 20th, 2014 12:48am

I was trying to stretch my back so smart me whent to the restroom at tjmax and I saw what it look like a metal bar that was across from the rrsyroom inside the stool I grab the bar and put all my weight on the bar; little did i know that the metal bar was loose while I was hanging the nails and bolts of the bar came off this happened in a second next thing I know I was strike hard on my left top of my head with like a 30 lbs. Metal an automatic knot was developing on my head. I was mad also the bar came down so hard I'm glad no one watch. I walk away from the incident after that I being feeling stupid like I feel like I don't know what I'm doing. But I'm smart enough to explain the cituation.

Jul 4th, 2014 3:41pm

I was taking surfing lessons yesterday and the board came back and hit me on the head it left a scratch an formed a knot immediately. I felt very faint and couldn't feel my legs very well and had to get pulled out of the beach it was all slow motion. They're we're fire fighters there that were giving the lessons and looked at my eyes and just made me sit down with a cold pack for a while now the knot has gone down some and I have a large bruise underneath the skin and it just burns some

Jun 19th, 2014 11:43pm

It is very important that you go to a hospital when you hit your head. I collided with a player in a soccer game recently and I thought I was fine. But my parents and coach convinced me to go to get it checked out. It turns out I had a pretty bad concussion and I was out of everything for 2 1/2 months. If I wouldn't have gone symptoms could have gotten worse and I could have gone into a coma. Moral of the story is to always go to the hospital or doctor when it's a head injury because it can't hurt even if nothing's wrong.

Apr 15th, 2014 7:39pm

My 85 year old dad blacked out, hit his head on the door jam as he tried to catch himself. He bruised his hand badly and has a clot on the back of his head in the nape area. He was is the hospital for 3 days and nursing home for three weeks for 24 hour care. He still has difficulty with standing and cannot walk. He will be coming home later this week. Any advice on similar experience is welcome.

Apr 13th, 2014 11:17pm

I jumped and fell on my head and i have no injury but lost my memory if what happened that minute and think i got blacked out but my friends say i got right up so should i visit a hospital awnser me plz

Apr 11th, 2014 8:27pm

I got hit in the head with a badminton racket and I have a bruise and it only hurts when you touch it. Should I still go to the hospital ?

Apr 11th, 2014 7:58pm

I got hit in the head with my boyfriends tire pump thing and I am dizzy and have a headache should I go check in a hospital

Apr 10th, 2014 10:45pm

I fainted at work 3 weeks ago and banged my head, i was very confused and got moved to a comfy seat, i fainted again, my employer asked if i wanted an ambulane and i said no as i didnt no what i was saying( confused, so they sent me home and briefly told my partner what happened. I was being put to bed when iv fainted again and after that i was unaware where i was, my daughters DOB so an ambulane as called and i was taken in . Had CT scan and iv got a 3" fracture on my skull. Now should my employer seeked medical advice when i was in work, did they act irrisponsibly by sending me home. Could my sever mental loss have been prevented if i had not fainted the 3rd time

Mar 23rd, 2014 8:43pm

I fell on the back of my head and had a headache all day.. It is like a dull, throbbing pain.. The symptoms are similar to a concussion but I don't know if I want to go to the hospital... I don't know what's holding me back... I don't know what to do but it's good that I got it off my chest.

Mar 15th, 2014 1:42am

This is THE article on the internet that convinced my very stubborn husband to go to the emergency room.  He fell on the ice, suffering a concussion with the associated amnesia.  He refused to go to the ER for a CT scan for over 24 hours, until I showed him this article.  Fortunately, he did not have a brain bleed, which is the reassurance I so desperately needed.  Thank you!

Feb 17th, 2014 2:50pm

What should i do if i got hit in the back of the head with boots?

Feb 7th, 2014 3:11pm

i hit my haed 2 days a go haerd and i was ok than got a bit dizzy but ok now but stell in pain sould i be worried

Jan 18th, 2014 1:02pm

I had  a road traffic accident last September 26,2013. I am a passenger. I was sitting in the front when a car hit us on my left side. I felt the pain from my neck neck to my arm with pins & needles. Later, sore in my ears & light headedness. I was given gabapentin 400mgs TID. But then my vertigo got worsen so  the Dr gave me betahistine hydrochloride. The pain in my left ear and my vertigo got really really worst. My inner left ear was really sore and the back of my neck is also sore. The headache don't go away. I will just cry at night because I can't do anything. I can't sleep at night. I have signs  & symptoms of concussion but my husband don't think that I am really sore. Please help me what to do.

Dec 22nd, 2013 7:49pm

Got hit in the head hard a couple dqys ago still feeling pain should i be worried

Dec 18th, 2013 1:05am

Hi I was playing basketball and some girl air balled it hitting me on the back of my head. I just have a headache. Do I have a concussion?

Dec 7th, 2013 10:06am

I hit my head yesterday on my dresser and i seem to be fine. However my headache has not gone away since yesterday and there is a bump where i hit my head. I was dizzy after it happened but i think thats normal. I'm hoping it goes away i really dont wanna spend my day off at the hospital.

Dec 7th, 2013 6:14am

I hit my head on the bottom corner of a locker at school and it started to bleed it felt weird and I didn't do any thing cause I didn't know what to do.

Nov 26th, 2013 10:08pm

I hit my head on the side of a swimming pool.  I was doing a backstroke I didn't look back in time and I hit my head.  I didn't experience any bleeding or vomiting my head only hurt for 1 minute and then I walked it off and went to the nurse am I okay?

Nov 19th, 2013 5:47pm

i hit my head hard of of the corner of my dressing table felt fine but the next day had blurred fision headache that was so bad dizziness but then 1 week later i was sitting down and all my left side of my body went numb even my left side of my face then a got a burning feeling in the front of my head and the back of my head and in my left eye i felt like i was on fire but then it all went away in 5 min the hospital did a scan and found nothing rong has anyone else had the same problem after banging there head if so i would love to hear your story i still have problems like out of the blue my left leg would get heavy some time my arm and my ears go funny to

Nov 9th, 2013 12:33pm

I hit my head on the 8th october,2013. I felt like i wanted to vomit for awhile but then it dissapeared. My gramdparents didnt bring me to the hospital. I hit my head on a concrete floor. Should i go to the hospital?

Oct 9th, 2013 7:01am

Last night I hit my head on the pole of the trampoline and my parents wouldn't take me to the hospital and said "if it still hurts tomorrow then we'll take you on Monday when the doctor is open." But I don't think Monday is close enough. They just don't want to wait in a hospital but this hurts so bad, it feels like someone is stabbing the back of my head, my shoulders feel like someone is holding them still, my back stings with every movement, my jaw is bruised, I am dizzy, have a headache, nausea, strange vision, and they still won't take me. Anyway, thanks for the advice! ~Kelsee

Sep 22nd, 2013 11:18am

I was attacked last night were somebody had smashed a concrete slab on my head I was dazed and I fell to the floor should I b worried and I have got a cut on my head Mehboob khan

Sep 10th, 2013 3:11pm

about 3 years ago I was picked up and slammed to the foor while I was falling my head bounced off of a large porcline flower pot all I remember was laying their thinking my head was bleeding out and I was going to die. Anyhow I did not loss concousness and my head was not bleeding. I was in a bad situation and I never told anyone what happened. Since then I have had a lot of emotional problems and told I had ptsd. If there was a brain injury would it still show on a cat scan after 3 years or could a hit to the back of the head cause these kind of problems. if anyone has any ideas about this please contact me at jeanniehanrahan@yahoo.com

Aug 17th, 2013 9:34pm

I was playing netball when i fell and hit my head on the cement court. My head wasn't hurting then but now it is badly aching in that area and bruised. Should i be worried?

Jul 20th, 2013 7:11am

I was doing a handstand and walking down the wall backwards at home to stretch my back I slipped and in fear that I was going to hurt my back I turned sideways and instead ended up falling straight on my head from a foot or two off of the ground. I have absolutely no signs of a concusion and it didn't hurt for that long. Should I be worried

Apr 25th, 2013 9:48pm

hello, i got slip on the bathroom and I hit my back and head on the floor, and that time I'm conscious but I cant move my whole body for a couple of seconds like I'm Paralyzed.and when I stand up I feel dizzy and forget where I am, and after a minute fee ok, but feel pain on my back, and I go to the doctor after that day, and he just recommended me for the x ray of my back and they didn't see any damage, and he 'recommend me to scan my head, he just give a medicine for dizziness. now its already 7 days past when the incident happen but I still feel dizzy specially when I move my head and when I stood up from the bed. can you please help me and give some advice what to do exactly? I really appreciate form any response, and please give advice to my email, shechaher@yahoo.com

Apr 18th, 2013 2:29am

i just knock my head on the floor but i dint have any of those symtomps all i had was feeling like blood gushing througt my forhead then i was confused for awhile and started having headache should i go to the doctor?

Apr 15th, 2013 8:06am

Wow this helped alot. My 8 year old daughter was playing basketball and fell on the cement and this info helped me perfectly!!! :)

Dec 20th, 2012 3:02pm

my son is 6months ols and hit his head on the table. he has a littl knot but is acting like himself. should i take him to the doctor/

Jul 10th, 2012 6:17pm

Thank you for your helpful information on head injuries, my mother fell hitting her head full on the concrete floor. We were not so sure if she should go to the hospital or not, looking it up on the web we found this website, which answered all of our questions right away! We now all know that the best thing to do is get information from some one who works at a hospital, so my mom called a nurse for her opinion; the nurse told my mom that it is not as bad as she thinks. -thanks again!

Mar 12th, 2011 1:39pm


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