When to Go to the Hospital

Question: 

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"?

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!

Posted on BrainLine April 8, 2009. Reviewed July 25, 2018.

Jeffrey Bazarian

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.

Comments (297)

a few weeks back i hit the left side of my forehead accidentally on the wall frame n i put ice on it. i took panado and it eased the pain. it was a bit sore but no bleeding or bump appeared. the uneasiness comes now and then. however today i woke up with pain on that side. i put ice on it again and it was quite painful. the pain was going down to my left eye and left temple. i took two panados. the pain is easing away. is it something for me to be concerned about? do I have to see a doctor?

My wife slipped on the ice and fell straight back on her head. She seems to be fine , just very sore and a nice lump on the back middle part of her head just above her neck. Neck is tight and sore. Not sure if I should make her go into ER or just keep an eye on her?

I fell last Monday striking the back of my right side of the head. I saw my optometrist and had a full retinal scab that showed no brain bleed. I did go to the chiropractor felt great the first couple of days however I cannot stand without nausea, a headache and right sided pain. I cannot stand bright lights. My husband thinks I’m faking. I don’t feel like my self. I am a nurse and know that concussions take time to heal. What do you if you can’t even stand? Without vertigo?

Earlier today, I was in a fight and got punched hard on my head. It didn't hurt at first but after about 20 minutes I begin to have a huge headache and when I touched where I got hit at there is this knot. I've had this headache for over six hours now and I don't want to go to the hospital for something mild and not serious, what should I do.
P. S. I'm only 14, would it be serious?

I was punched in my face and supposedly knocked out. I got told i was unconscious for a short while, and they poured water on my face to try and wake me. Eventually i responded and reportedly drove home. I do not remember driving home, i do not remember getting punched or anything. When i woke up the next morning there was blood on my pillow which drained from my ear. I cannot look at bright lights or hear loud sounds or its excruciating. The next morning i was vomiting and couldnt hold any food down and my head has been in constant pain. I dont know if this is common for a concussion and i should kust keep resting and taking aleve, or go to the hospital. I already have a lot of medical bills and cant really afford anymore but if its the difference between life and death or serious injury i guess ill go. I just dont know what to do.

Earlier, about 3 hours ago, i was at the park with my friends and i was on the swing. One of them pushed it really hard and it flipped over, taking me with it. I hit the back of my head pretty hard and I was really dizzy for a few moments after. When I went home, i started developing a headache and felt sleepy. I told my parents during dinner and they were concerned, and told me to get some sleep. As i was getting ready, my back suddenly started hurting. I was told to just lie down with like 3 pillows elevating my head. I'm worried on what to do next. Is this serious?

ive sustained a head injury yesterday evening. i stood up while sitting on the lower bunkbed and hit my head realy hard. i didnt vomit and there dont appear to be any bleeding. immidiatel after i had trouble keeping my eyes open, felt like i going to throw up (which i didnt) and had problem with balance. i quickly got to the 24\7 clinic where there theykept me for an hour and half to watch me and see if everyhting is ok. after thaty i was released since i appeared to feel better. a shower later and a terrible headache at night i woke up in the morning sensitive to lights and strong sounds. my head is still sore and the place which connects to my neck is as well. im worried, how do i know ill be fine and my brain isnt slowly bleeding out? the doctors there assured me im fine and gave me advil for the pain but i cannot be sure.
sincerly a concerned young adult.

Hi I got hit with a bottle of water half full someone was trying to throw it at my friend but unfortunately it hit my back right side of my head so it didn’t hurt at first I thought wow that hit hard so about a week or so later I notice it hurt in that spot I touched it nothing was noticeable by touch so a few days later it quit then I think I pulled my neck muscle cause my neck was a little stiff for a few days it’s healed pretty much now but it’s been a week like I said after the water battle thing now I feel a little dizzy later in the day and tired in the middle of the day and off balanced a little I haven’t lost conciseness or anything severe

Is there any recommendations for me to do to heal it I believe I have a concussion or a small one at least I hope

So I have been having seizures right but the doctors tell me they are pseudo seizures. I don’t know though. I have the worst symptoms ever. My head goes numb, I have verdigo, nausea, weakness on one side, slurred speak at times. Nobody will listen to help me and all my parents think I am fine and just tell me to get over it. Plus the doctors won’t do anything and won’t let me have a ct scan Because my one a few months ago came back normal what should I do I feel like I’m getting worse

You should continue to go to your doctor and seek a remedy for your medical problems. If he/she does nothing, you may need to change physicians.

On October 27, 2018, I fell hitting my left brow bone on a cement floor. It was bad enough I should have called 911. I am on SSI, very TIGHT budget. Lucky to get groceries. I hurt so bad, touching it was not an option. I had the whole left side of my face, both eyes and my ear, almost back with purple, orange etc. Started having blurred vision and bad headaches. Now I am having them 24/7. What should I do?

Glad to know I’m Not alone here! I’ve been sleeping a lot ( it’s all I do!!) after being hit on the back of the head & back by my apt buildings front door! Swung off the hinges & hit me HARD knocking me down. Having all symptoms of a concussion, guess I need to go to ER!

I slip while I'm in the shower and I hit my right side of my head. I was dizzy for few seconds. I need to know what I should look for after this incident?

I know the feeling I have fallen 6 times in the bathtub hitting the back of my head and neck every time. My husband and I work opposite schedules so when I'm in the shower he is fast asleep. This last time gave me such a headache trying to sleep is painful because no matter how I sleep it hurts. My doctors act like its no big deal because I didn't pass out.

I fell backwards and hit my head on the concrete 4 days ago. I felt weird, shaky and tingly after the first day. The last 3 days I still feel kind of weird and all I want to do is sleep and that is not like me to do. I am thinking of going to the ER but not sure if I am overreacting or not.

I fell 3 days ago. I fell face first hitting my forehead then my nose. It hurt so bad I was screaming a d crying. Blood was everywhere as my nose was bleeding like crazy. I am also taking warfarin (blood thinner). I had a really bad headache too. I felt at the time I should have gone to the ER to be safe. My husband thought I would be okay so I didnt go. I no longer have a headache. I just want to be assure since this happened several days ago that I am okay. I have 2 black eyes and a huge knot on my forhead besides that I feel okay. Nancy Q

I had a reaction to eating seafood 6 nights ago, I fainted twice and fell face first in the bathroom tile. Goose egg over right egg brow, swollen nose bridge, and cut up gums above top teeth, luckily no blood. I went to emergency, they did ecg and blood test but they never checked my head or brought up concussion stuff, yesterday I was totally fine, today my forehead has mild headache, I’m hoping this is from healing and not some internal bleeding or concussion...? Ugh, anxiety gets the best of me!

I fell this morning. I landed on by back on our front porch, I was dizzy and could not get up for a few minutes. this happened about 4:45 this am, I was getting ready to leave for work. now at 10:00 am I feel dizzy and have a headache. I just don't feel right. need advice on what I should do.

Shit. I fell yesterday. At lunch. Walking back to the work truck. Fell hard. Landing on the back of my head. Like straight on the back of my head. I weigh 250. 6'0 tall. I hit HARD! Hardest fall ever. And today, I can not get up on my own. The muscles in my neck feel like I'm being held down by my throat when I try to get up. Everything hurts from my back to my calves. It's super crazy.

I hope your okay... I would say get checked out to make sure nothing major is wrong.

Yeah, go to the ER...

My husband has stitches on his forehead and scrapes on the back of his head. He went to the hospital and they said they would call us if he had a concussion. They did a CAT scan. Should I keep checking on him tonight or can I go to sleep and not have to worry?

I was struck on the left side of the head with a foam dodge ball really hard and I started to cry and freak out. At first, I thought it just shook up my nervous system and didn't think about it, but after at least 5 hours, I still feel pain whenever I move around. I feel it on the top right side of my head if that helps. Is this a concussion or did I just get a headache? I feel like I should go to the hospital but I don't know if it is very serious or not. Should I go?

my husband fell on ice in the driveway. fell flat on his back and smacked his head. He got up, was fine, about 1 hour later nausea and headache. He never got checked out. Now he has pressure behing his eyes, bridge of nose, etc. sensitivity to light and reading? Should he go to ER?

I hope you did! These are tel tell signs of a concusion

Yes! And lots of rest! No TV, phones, reading, stress etc! I wish someone has told me this early on! It took me 5+ years to feel normal again

I was trying to hang an air freshener. I'm 5'3 so I use a step stool. I slipped off of the stool and the air freshener slipped out of my hand and hit my temple. I've been dizzy/light headed since. Any thoughts?

Years ago I was an assistant manager at a convenience store. I was working 2nd shift with one other employee who hit his head really hard on a low doorway to a cooler. He was dazed and kind of slurring his speech and couldn't stand up without leaning on something or focus his attention on anything. I couldn't take him to the hospital because I would have had to close the store if I did and there was nobody else I could call in at that hour (about 11 at night). I also didn't want to call an ambulance because the kid had no insurance and no money. So I called the Manager and said that the employee was injured and needed to go to the hospital. The Manager reluctantly came and got the kid and took him to the ER (and had to wait there with him for hours). He came back and told me it was "just" a mild concussion and fired me. I always wondered if I was really in the wrong for insisting that he had to go to the hospital. I appreciate this article because now I finally feel vindicated.

You did the right thing. My mother is an HR director for a factory. She would insist her employee seek medical attention if there was a possibility of a concussion. Your boss was a d*ck and you could have fought that. That's bullsh*t. Good on ya though! You were justified!

That’s a violation of Labor Laws. You are protected by OSHA Whistleblower Law for reporting workplace injuries. Get a good labor lawyer!

God will open up another door of better employment for you, keep doing the right thing as for the manager pray for him clearly his heart was in the wrong place.

You could likely sue for wrongful termination! You did the right thing but next time call an ambulance!

My friend bang her head on a ice skating ring. She feels a lil dizzy right after she bang her head. And had a lil head ache. Should she go to the hospital?

It happened to me this evening, I was going along building up speed & within a split second I was on the ice with a paramedic helping me up! The back of my head was bleeding bad, I put my hand on it & my hand was satuated in blood. I think "Novice Ice Skaters" should wear head gear of some sort seriously...

About 27 hours ago I was struck in the mouth by a piece of firewood and my lip and adjoining area split and some front teeth are sore. I was stitched up at Urgent Care where my husband drove me. I woke with a headache this morning and some ringing in my ear (which does happen now and again). The headache is getting worse despite having taken Tylenol. I was unable to eat last night so not sure if that is a factor but I'm not sure if I should be worried about being alone when my husband leaves for 2nd shift work. Do headaches continue to intensify over this time period? I did not lose consciousness and was able to grab a handful of snow to hold against the wound and walk out to find my husband at the wood lot to have him drive me. Not sure what else I should mention. The NP who stitched me up never mentioned concussion to me as a concern although I did feel woozy. The office was very busy so maybe it was an oversight?
Thank you for any feedback.

This happened on Thanksgiving, it was around 11 pm and I had taken my medicine, seroquel, when I was leaving the bathroom my vision when blank and I woke up in my room. I remember hitting my head on my desk and waking up on the floor. It was just a complete collapse.

My heart was beating quickly and I was shaking.

The last two days I’ve only felt worse and I’ve felt this constant steady pressure on the right side of my head, I’ve been dizzy and just out of it. I know that two days has gone by but it feels like it hasn’t been that long at all.

I had to leave work early today because there were too many noises and I just felt so dazed.

I’m pretty sure I have a concussion but idk it I should go to the doctors or the hospital. I feel fine, just out of it and just so sleepy all the time.

You should DEFINITELY go to the hospital!!

Your situation is a particularly alarming one and definitely requires the expertise of a well-qualified medical specialist. Go to the best facility you can.

This happened on Thanksgiving, it was around 11 pm and I had taken my medicine, seroquel, when I was leaving the bathroom my vision when blank and I woke up in my room. I remember hitting my head on my desk and waking up on the floor. It was just a complete collapse.

My heart was beating quickly and I was shaking.

The last two days I’ve only felt worse and I’ve felt this constant steady pressure on the right side of my head, I’ve been dizzy and just out of it. I know that two days has gone by but it feels like it hasn’t been that long at all.

I had to leave work early today because there were too many noises and I just felt so dazed.

I’m pretty sure I have a concussion but idk it I should go to the doctors or the hospital. I feel fine, just out of it and just so sleepy all the time.

I have depression and I hit my head a lot. I have many headaches, and sometimes I forget things really easily. My dad says that I don’t have an injury in my brain. He’s a anesthesiologist so he should know about this stuff. I’m still not sure though, so I just want to know if I have a brain injury or not.

Hi
I triped and tryed to catch myself. In doing this I ran head first into my front door. I hit the left side of my head hard. I didn't black out. I had a large bump on my head. Now it's 3 daya later. Bump went down but head still hurts and it hurts to touch the area. I feel a bit like my head is in a cloud. Should I get checked out or give it time?

I tripped and fell into a brick wall hitting my head off of it and fell down on my knees this past Tuesday (11/20). I went to the ER to get checked out...had multiple x-rays done and was diagnosed with a broken nose, sprained wrist and bruised ribs. I am having horrible headaches since and have started to feel nauseated and a little lightheaded...mind you I did not black out on initial injury. Should I go back and getting rechecked?

26yr son said felt dizzy and fell on kitchen floor hit head on door fridge went to get up fell again and hit side of face on floor..refusing ambulance and taking to dr.. Kept checking on him every hr when sleeping ..how can i help as a mum

I got up to fast from my bed, fainted, hit my head on the back of my head pretty hard on my carpet but then i woke up from the faint immediately, my neck hurts but i feel fine, should i be worried?

Got a small injury above my left eyebrow just near the temple with a steel ring it's a small injury but swelling and bleeding were there..... after 2days severe headache started in temporal region to occipital region 24/7 pain... back of my neck also paining then while sleeping i couldn't turn my head so that i woke up,while opening my eyes I felt very sharp pain in occipital region.... then after 1 or 2 mins I was able to turn my head... why is this happening?

Two days ago I hit a slick spot on my porch and hit my head full force I went a day later to the hospital and the did a ct scan and said everything was normal both sides of my neck hurt and head has a lot of pressure and base of neck is sore and I still feel weird it that normal

I have taken several blows to the head and my head is swollen around my temple arteries, what do I do?!

I fell on my face Monday. I went to the ER and had X-rays and CT scans. No brain bleed and broken bones in head or face. Broken wrist and nerve damage. Diagnosed with a concussion. Vomiting and nausea, pressure and migraine day 2 and 3. Should I go back to the hospital?

Absolutely

My friend sasha has a bad migraine and she noticed bumps on her head and she was bleeding. What do me and sasha do to stop the pain?

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