Concussion: The Daily PANCE Blueprint
A 15-year-old girl is brought to the emergency room after hitting her head during a soccer game. She collided with another player, falling onto the ground and striking her head. She was not wearing a helmet and lost her balance but did not lose consciousness. She reports feeling nauseous, slightly dizzy, and fatigued but denies vomiting. On examination, she is alert and oriented with normal sensory and motor function. Her memory and cognition are intact, and she can recall the events leading up to and following the collision. There are no external signs of head injury, and her vital signs are stable. What is the next best step in management?
A. CT scan
B. Discharge patient with clearance for full activity
C. Discharge patient with activity restrictions
D. Electroencephalography (EEG)
E. Referral to neurologist
Answer and topic summary
The answer is C. Discharge patient with activity restrictions.
This patient has suffered a concussion, a form of mild traumatic brain injury typically caused by direct impact to the head. Symptoms like nausea, dizziness, and fatigue are common following a concussion, but the absence of loss of consciousness and normal neurological exam findings indicate that imaging is not immediately necessary. The next best step in management is to discharge the patient with activity restrictions, advising a gradual return to activities based on symptom resolution. The patient should avoid physically demanding activities and cognitive strain (e.g., schoolwork) until symptoms improve. Rest and close monitoring are key to preventing further injury.
ncorrect Answers:
- A. CT scan: While CT imaging is useful in cases of severe head trauma or neurological deficits, this patient’s normal exam and lack of concerning symptoms (e.g., vomiting, altered mental status) do not warrant immediate imaging.
- B. Discharge patient with clearance for full activity: It is inappropriate to allow full activity after a concussion, as premature return to sports or cognitive tasks increases the risk of worsening symptoms or further injury.
- D. Electroencephalography (EEG): EEG is used to evaluate seizures or abnormal brain wave activity, which are not relevant in this patient’s presentation of a mild concussion.
- E. Referral to neurologist: Referral is not immediately necessary for most cases of mild concussion. Follow-up can be handled by a primary care provider unless symptoms worsen or persist.
View blueprint lesson
Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Neurology ⇒ ⇒
Also covered as part of the Emergency Medicine EOR and Internal Medicine EOR topic lists
