Dizzy and nauseous following football collision and suspected closed head injury


• Transported to specialty hospital
• En route, patient refused IV. Patient rested and visited with medics.


• Unknown


Elliot Williams, Paramedic Woodburn Ambulance


Merlin Curry, MD Paramedic University of Arizona


• Concussion

Differential Diagnosis

• Cervical spine injury
• Intracranial hemorrhage
• Seizure
• Sudden arrhythmia
• Hypoglycemia
• Concussion

Patient Workup History

• Upon regaining consciousness, patient did not recall event. According to others on scene, patient may have forgotten up to 20 minutes before hit.
• Was wearing pads and helmet; was able to remove gear himself
• Patient was very dizzy and nauseous right after hit. States that he threw up a small amount into his mouth. States that he is still nauseous when he stands up.
• Patient states he feels slightly more sensitive to light and also complains of a right sided head ache
• Patient states back pain in between shoulder blades at 2/10. Patient also states “normal soreness” associated with playing football.
• Patient and mom both state that patient has not been feeling well for a few days prior to this injury, that he had a headache
• Mom is concerned about cumulative injury from contact sports

Physical Exam

• Prior to arrival, on scene fire department states that patients right pupil was not equal and not reactive to light, but in back of medic pupils perrl
• Physical exam shows normal minor traumatic abrasions, all superficial, in various stages of healing, consistent with wear and tear from football
• No gross or new injuries noted, physical exam is otherwise unremarkable
• Denies any numbness or tingling in arms or legs. Denies SOB or difficulty breathing.
• GCS 15
• Vitals all within normal range
• 135/77
• 82 NSR
• 16 normal 100% room air
• AOx3, not to event

Key Points From Ems Editorial Board Member Merlin Curry, Md, Paramedic:

• Consider the need for spinal precautions in this patient. Explain how local protocol guides decision-making in terms of the patients who need spinal precautions.
• Monitor for changes in mental status. Consider cerebral edema if successive concussions are less than 2 weeks. Active mental status changes en route may indicate intracranial hemorrhage.
• Obtain a glucose, consider an ECG. These will address more aspects of your differential.

Editor’s Notes Questions for discussion:

Does simple concussion require transport to the ED? Should this patient be transported on a board with a collar with absence of neck and/or back pain?


• Gender: Male
• Age: 16 years
• Height: Not Available
• Weight: Not Available


• Temperature: Not Available
• Blood Pressure: 135/77
• Heart Rate: 82
• Respiratory Rate: 16
• Pulse Oximetry: 100% RA

Signs and Symptoms

Dizzy, nauseous, slight vomiting; pain between shoulderblades

History Medical

• PMH: 1 prior concussion, 1 year ago, sustained after he was held in a choke hold and then he fell forward. Hx anxiety. • Dispatch info: Dispatched to local high school for 16yom who lost consciousness during a tackle while playing football. Patient was knocked out on the field for unknown amount of time.

• Medications: Prozac

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