Dizzy and nauseous following football collision and suspected closed head injury

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