When to Go to the Hospital

Jeffrey Bazarian, MD
Question: 

People 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"?

Answer: 

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!

When in doubt, go to the hospital!

 

Please remember, we are not able to give medical or legal advice. If you have medical concerns, please consult your doctor. All posted comments are the views and opinions of the poster only.

Posted on BrainLine April 8, 2009. Reviewed March 28, 2019.

Comments (483)

Lovely replied on

My son felled and hit the back of his head. Started to complain of a headache 2 hours later should I take him to the ER

Mary Magdalen replied on

Slipped and fell backwards in a train 2 fays ago. Back of head hit a hard surface. Was shaken up a little and developed a swelling on head followed by persistant headache. Restless sleep. Feeling Nausea. Doctor prescribed treatment for headache only. Is there need to get further treatmwnt please? I am 63.

Suzanne replied on

I fell face first into The doorframe 6 weeks ago. I didn’t break my nose yet had lots of bruising. It took 10 days to look decent enough to go out in public. Now I wake up with numb/tingling in both feet and hands. Had an MRI. It came back normal. I had forgotten to mention my fall to the dr. And the mri tech. Can an MRI show if I have water on the brain or bleeding on thembrain

Myrna replied on

I hit my head while in the bathroom last week while having to pick something up and again tonight . I’m gonna go to doctors and get ct scan performed also. Better to be safe than sorry

C. Lee replied on

Is it possible to receive a brain injury and not show symptoms for a couple of days?

Adrian replied on

My roommate cut himself by accident in front of me. I got so scared that I fainted and hit my head on the floor.
My roommate tells me that after I hit the floor, my eyes rolled all the way to the back and I had a seizure but it only lasted 3-5 seconds. Then I stood up and went back to normal.
I feel good today, I only feel a minor bruise in the back of my head.
Should I go to the DR. or am I overreacting??

Nestorbalote replied on

And u see the the house falling down ? Maybe they see it as seizure cuz of that and u go to the hospital ? Please reply ASAP

Hazel replied on

I fell hit my head 2 weeks ago , went to hospital had CT scan no brain bleed. Have increased tiredness and a little nauseous. I am also short winded even when resting. I feel like I just ran up a flight of stairs.

Louise replied on

My son was diagnosed with Spastic Paraplegia #20 complex. age 36 diag/3 years ago. He told me he has fallen many times due to balance issues. For the first time today I saw him fall and bang his head on the cement driveway. He stayed cleared headed, as for some assistance, but got up and said he was not feeling sick . Refused to go to ER. My concern is with leisions on his brain, could this make him more apt to get a bleeding in his brain as his brain is shrinking as well.

Christina replied on

I banged my head last Wednesday and the headaches are never ending. My head feels so heavy and my eye hurts on the side I hit but my vision is fine

Olivia replied on

Same here. Do you feel pressure on your temples? I feel that then get light headed and my legs feel weak. Only been happening a few days after my incident

LaWana replied on

Consult with your m.d. about having a MRI done.

Brenden replied on

Hey i had gotten up out of my gamer chair really fast after did that i got really light headed and blacked out. I hit my head on the door and a metal candle lid. When i regained conceness a few minutes after my whole body was tingling. Now i just get migrains, feel nausios, feel depressed, having a hard time sleeping, and feeling drowsy all the time. Should i go to the hospital or no??

Connor replied on

I would man. Sounds scary

Skye replied on

You should definitely go to the hospital asap

Bobbie replied on

Yes felling like that isn’t normal any time your not your normal self go to the doctor you should know what’s normal and you and what’s not you.

Justin replied on

Did you go to the hospital? What happened?

Anna replied on

Yes these are signs you need to go ASAP

rylie replied on

yes, most defiently i would have someone else drive you there. yeah you could have brain damage

Anastasia replied on

Yes,pls u should go to the hospital and check out if every thing is fine.

Hi replied on

Yeah go to the hospital

Nikki replied on

Yes. Absolutely go.

Megan replied on

I know the article said to go to the hospital if there was any doubt but I just really want a second opinion right now because it's 9:30 PM where I live and I don't want to have to make my parents go out if they don't have to. At dance practice today, I was practicing a certain acrobatic trick and we didn't communicate well enough so I was dropped extremely hard on my left cheekbone and still very hard on my lower right side of the back of my head. Initially, I felt extremely dazed, my vision became dark and spotty in certain places, especially the edges, my head hurt on the location of impact (obviously), and I just wanted to close my eyes and not move. This went on for about five minutes and after this, I just felt out of it and a little dizzy, but I continued practicing (with a lower intensity of course) after my dance coach checked my pupils to make sure they were dilating properly. This happened at about 6 PM and I continued to feel better until now because I just feel very anxious and still out of it and I don't know what to do. I don't know if I'm just shaken up by what happened and now I'm overthinking it, but now I'm just scared and I need opinions. Please help me.

Recoveringathome replied on

Yes go to the hospital. It doesn't matter what time it is the fact is you have persistent symptoms. And if you leave it you could end up being placed back in a position that makes it worse or you could potentially die in your sleep especially in the first 24 hours. It happens. You dont want that so go in even if it's only slightly affecting you. Better to be safe then sorry

Tanya replied on

I hope you went to the hospital and you are ok..I happened to read your comments on here about your head injury but just realized it was back in April so I'm hoping the outcome was good for you..

Marie Elizabeth replied on

Should you always go to the hospital when you hit your head and have a lump and are just stressed and scared and just have a slight headache from nerves maybe

Mea foodie replied on

I hope you went to hospital and are okay

Concerned replied on

I hope you did go to the hospital if not go right now. Even if you are feeling better. Since you were dizzy and had vision disturbances after falling.

Jordan replied on

Never resume activity after a hit to the head that leaves you dazed. At that point you’re brain is basically weakened, and if it will be much more sensitive and vulnerable to getting shaken around from al the jumping and what not while cheerleading, possibly worsening the injury. If you’re still having symptoms, my number 1 advice is don’t hot your head again anytime soon. Avoid it at all cost. Like don’t even bump your head on the headboard when going to sleep. Nutritious food (fatty fish esp), limit screens in the evening and night so you can get to sleep at night, get morning sunlight (which will also
help you sleep at night), go for walks, etc.

Kim replied on

On Sat. 4/7/18, I slipped on ice and fell backward, landed on my back and hit the back of my head really hard. I was a little disoriented at first, but just for a minute or so. I worked the rest of the day and had a Dr.s appt on Mon.4/9/18. My Dr. asked me if I vomited and if I had a headache. I said no, but I didn't mention that I have been sick to my stomach, but have also been going through a lot of stress. The Dr. said I had a hematoma and it would heal on its own. Since I'm sick to my stomach should I go to ER & get brain/skull scan? It smacked the concrete extremely hard, I couldn't believe that when I reached to the back of my head there was no blood. Should I be worried being its been 3 1/2 days now? I still haven't had a headache. Only sick to my stomach, but think...I was before this happened? My family Dr. is pretty smart, he has even given and read my stress test, which I was impressed with. So am I okay or should I get checked anyway? A little worried is all. Where I hit, there is blood under the skin and a little squishy, like I said, he said: "it was a hematoma and should heal on its own."

teresa replied on

So did u get a CT

Angela replied on

I got my fourth concussion about 5 weeks ago, my third in ten months. I was in two accidents last year four months apart, then this last one was at work. I've seen the workman's comp doctor and he has turned my care over to a neurologist, whom I can't get into until May. I've been symptomatic this entire time: constant headaches, ear ringing, vomiting, balance issues, blurred vision. I've fallen twice since the concussion, resulting in contusions on my head. The pain and vomiting were so bad last week I went to the ERer, and the doctor said I was wasting his time and he couldn't help me. He also said if I was there for painkillers, I needed to get out of his ER. I felt humiliated and depressed that no one can help me feel better. Was that doctor out of line and what do I do for some relief while I wait to see the neurologist?

MP replied on

Yes. The doctor was completely out of line. You should have asked to speak to a hospital administrator or the appropriate person over him. Report him to the proper authority and don’t back down. Given your symptoms you could have been/or are in serious condition. Seek a second opinion if u haven’t already. Gl.

Bridge replied on

Seriously, you need to get a 2nd opinion, that Dr needs striking off! I have been to A&E today with the same as you and the consultants did a thorough check and a CT scan too. I'm okay just concussion no bleeding in the brain but I now have to take time off work and rest up. Take paracetamol only and get plenty of rest and it could take a while to get better, if not better this time next week I am to go straight back up to A&E. I feel crap but confident of full recovery having been to A&E but wish I'd gone straight away which is what they told me I should have done. Good luck, I hope you get it sorted soon. If not then lodge one helluva a complaint and remember to the Doctor's name for the complaint. If you have to wait for the Neurologist then I suggest you take the time out to rest up and take paracetamol only whilst you do.

Cetkat replied on

It's a little late; but, yes.. the doctor was out of line. If you ever deal with that again, you should retort that you're not here for the pain (though of course it's a concern) - you're here because you've had multiple head injuries and haven't been able to access proper care and accessment. You need a consult with the neurologist on call and to get any imaging they think you my need -- that your first injury hasn't improved & has directly caused additional head injuries & you need that to stop happening. Also, if you get shit on like that again, you can tell the nurse you need to speak to a social worker. They can advocate on your behalf. I hope things are better now.

Abdullahi replied on

The way he treated you wasn't nice, though I can't tell the manner of approach you did or how you explained your condition. But I'll advice you to see another medical practitioner. (I'm not a specialist though, just my opinion).

#concussed replied on

Hey there. That doctor seems way out of line. Brain injuries are very serious and considering you have persisting symptoms they should of done some scans to make sure everything was okay and rule out any bleeding in the brain. You can take panadol but don't take anything like ibuprofen. Also dont drink alcohol as it thins your blood

Teri replied on

I recently rolled my car (3/22/18) and developed a large cranial hematoma. A CT scan was done and they released me. On 3/27, I started having a headache and the goose egg seems to be getting bigger. I don't want to be dramatic and run to the ER. . . . . Suggestions??

Anonymous replied on

Have you put ice or something cold on it?

Rebecca replied on

GO TO THE ER!

It is important you go. They won't think you are dramatic. They will think you are smart even if it turns out to be nothing. It doesn't hurt to go it could turn into something. You had a very big injury. Something more could have formed such as a head bleed that is deadly. Take my advice go now it can never hurt.

Diana replied on

I went to close the tailgate of my car with full strength and hit the middle of my head. This happened Friday, I am still in pain and have headaches. Should I go to the ER? I have had two concussions before this so I'm pretty sure it is a slight concussion

Blas Guzman replied on

Help, I was assembling a weight lifting chair and before even assembling anything, one of the legs tipped over and hit my head causing a small cut towards the front almost the side of my head. Bleeding stopped very soon and I never lost consciousness but I do feel a little bit dizzy and nauseous. The cut is not bleeding anymore but I'm worried. Should I go to the hospital.

Cory replied on

Yes you should go to the hospital!

Lee replied on

So i fainted and became unconscious for a min or so my friend was there he said i hit my head on the way fown but i just sat kind of crumbled after i woke up i felt sick to my stomach i stood up after i got my barrings and felt okay to walk i took 4 steps and fainted again ive never had this happen now ive felt tired and achey all over for the past 20 hours or so should i go to the er im really nervous

Rima replied on

I really think you should!

DIanna1 replied on

Um... you all just need to go to the doctor. If you are even asking that question because you are not feeling “right” in any way after a blow to the head. Then yes, seek medical attention. Better to err on the side of caution...

J. E. M replied on

I just fell of my bike today, messed my elbow up pretty bad. Anyways, I can't remember if I hit my head hard or not at all. There isn't a blemish on my skull. I did some research, and an online test, but I think i'm fine, and it's just the adrenaline. I don't feel "right" but im going to check in with the family after a bit. Just to see if it progressively gets worse. I heard that it can take upwards of 24 hours for symptoms to appear so i'm just a tad worried. But that's just the thing, if you fall, and can't see/feel an issue, how do you even know you hit your head in the first place? For all I know I only scraped my elbow badly. This is a very worrisome issue, but I heard the chances of having a concussion are about 1/1000. If you do suffer from memory loss, fatigue, drowsiness, etc. I'd personally get checked out.

PS: WEAR A HELMET, I'M LUCKY BECAUSE THERE WAS A NURSE AT THE PARK WHERE I WAS BIKING, I'VE LEARNED A VALUABLE LESSON

PSS: After rereading this paragraph I don't sound like someone with a concussion. I'm probs just overreacting.

Jen replied on

I hate it when people answer like that!! “Um all you need to do is go to the dr..”

eileen replied on

I hate it when people answer like that!! “Um all you need to do is go to the dr..”

the answer was "you ALL need to go to the doctor". There are places to go that will take you with no insurance.

Emma replied on

Sarcasm, ad nauseam... I'm with you Jen
There is nothing more precious than life.
Sad that the medical 'business' is beyond affordable to so many, leaving them wondering if they should seek help - when they know the really should, maybe even risking their life to avoid loosing their arm and leg to pay for, in most cases, their assurance.

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