Summer Safety

Concussion!

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If you follow “contact sports” such as football or hockey, you’re aware of reports of concussion for school, college, and professional athletes. Such incidents receive a lot of media attention and have resulted in controversy regarding rules of play, protective equipment, and limitations on participation or returning to play. As important as sports brain injuries are, they are not the whole story. Not by a long shot.

Contrary to media hype, falls are the leading cause of traumatic brain injury (TBI), accounting for 40% of all cases in the U.S. Among children age 0-14, falls account for 55% of TBIs. And among adults 65 years and older, falls cause 81% of TBIs.

Being struck by or against an object or person, including sports injuries, is the second leading cause of TBIs.

The third leading cause is vehicle crashes. They are especially serious and result in massive injury and death more often than other causes of TBI do. (Source: http://www.cdc.gov/traumaticbraininjury/get_the_facts.html.)

Such facts add up to a major conclusion: mild, moderate, and severe traumatic brain injury affects our daily lives more than we might realize. We need to be alert to the symptoms of brain injury in ourselves and others, and we need to pay attention to ways to prevent or minimize such injury.

Signs and Symptoms of Concussion

“Concussion” is the name most of us use for mild traumatic brain injury (mTBI) that results in temporary impairment of function lasting only 7 to 10 days. According to the CDC, signs and symptoms of such injury include:

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Observable TBI Signs

·      Appearing dazed or stunned

·      Forgetting an instruction

·      Moving clumsily

·      Answering questions slowly

·      Losing consciousness (even briefly)

·      Showing mood, behavior, or personality changes

·      Being unable to recall events prior to and/or after a hit or fall

Symptoms Reported by Persons with TBI

·      Headache or “pressure” in head

·      Nausea or vomiting

·      Balance problems or dizziness

·      Double or blurry vision

·      Sensitivity to light or noise

·      Sensation of feeling sluggish

·      Concentration or memory problems

·      Confusion

·      Not “feeling right” or “feeling down”

·      Mood changes, such as irritability, sadness, nervousness, anxiety, or acting more emotional than normal

·      Changes in sleep patterns
(Source: https://www.cdc.gov/headsup/basics/concussion_symptoms.html.)

Symptoms in Young Children

Because young children cannot tell us how they feel, it is often difficult to spot symptoms of mild TBI in them. Consider seeking medical attention if the following symptoms appear.

·      Appearing dazed

·      Listlessness and tiring easily

·      Irritability and crankiness

·      Loss of balance and unsteady walking

·      Crying excessively

·      Change in eating or sleeping patterns

·      Lack of interest in favorite toys

Medical Attention for TBI

It is important not to try to diagnose head injury or concussion yourself. The State of Connecticut Department of Education, for example, requires athletic coaches to permit athletes to resume participation in athletic activity only after having been cleared to do so by a licensed medical provider. If symptoms appear to be mild, it is probably all right to wait a day or so before seeing a health care provider. But if symptoms are more severe or if they become worse, immediate medical attention should be sought.

When you take the injured person to your regular physician or an urgent care center, you will be asked a series of questions about the person’s medical history, any current medications, and how the injury occurred. The clinician will check for observable injury to the skull and neck.

Evidence of amnesia or any loss of consciousness will be important. The injured person’s behavior—especially signs of dizziness, visual problems, feelings of nausea, sensitivity to light or noise, numbness, difficulty concentrating, irritability, etc.—will be closely observed. An X-ray exam will not be administered because X-ray does not detect health of brain function. Similarly, a CT exam will not be ordered unless there are signs of severe injury or trauma.

If a referral to another specialist is indicated, your doctor or health care provider will develop a follow-up action plan. Often, no follow-up beyond further observation at home for a few days is required.

Some situations, however, require referral to an emergency department or trauma center:

·      Apparent structural injury to the skull or other massive trauma

·      Headaches that worsen

·      Seizures

·      Differences in pupil size between the eyes

·      Extreme drowsiness

·      Repeated vomiting

·      Slurred speech

·      Inability to remember people or places

·      Increasing confusion, irritability

·      Numbness in arms or legs

·      Neck pain

·      Change in consciousness

Prevention

Since falls account for the largest number of TBIs in young children and elderly persons, preventing falls should be high on our agenda.

The activity of very young children should be observed closely. Child gates can keep them from gaining access to stairs, and window locks or other devices can prevent them from falling out an open window. Playground equipment should be checked for safety regularly, and the surface underneath such equipment should be soft, even spongy. Some equipment, such as backyard trampolines, should be avoided altogether (see my blog post on summer safety for children).

Parents must never shake young children because of irritation or as a form of discipline. Doing so can cause massive TBI that results in permanent injury or death.

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Senior adults should exercise in ways that increases strength and balance. Stairs should be well lit and furnished with sturdy handrails. Grab bars should be installed in showers and bathtubs. Use of ladders and stepstools should be minimized or avoided.

School children and athletes are generally required to have a physical exam before participating. They should also be educated about TBI and how to avoid it according to the particular sport that they play. Adult athletes should follow similar precautions.

Safe driving and wearing seat belts (or child-appropriate restraints) are essential to preventing the most massive and life-threatening TBI.

Final Thoughts

Traumatic brain injury—whether mild as in “concussion,” or severe—is a frequent, unwelcome feature of our lives. Often, it can be prevented or minimized. But when it occurs, all of us need to be able to spot the symptoms and to make sure that those who are injured receive the medical attention that they need.

If you or someone you know has suffered an injury to the head, be sure to watch for relevant symptoms of the type of injury that requires attention. If your regular health care provider is unavailable, get to an urgent care center where evaluation of such injury is frequently conducted. In cases of severe injury, call 911 or go to an emergency department.

For more information about traumatic brain injury and concussion, visit the major CDC website devoted to these topics: https://www.cdc.gov/traumaticbraininjury/index.html.

Traumatic brain injury is important. Don’t ignore it!

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Keep Your Kids Safe for a Fun Summer!

We all want our kids to have a fun summer. And most of the time they do without much help from us. Some of your happiest times were probably spent outdoors with your childhood friends. Your children are no different. They love to go to the beach, play at the park, swim in the pool, jump on the trampoline, camp out with relatives, hike in the woods, and so forth. Such activities help them develop physically and emotionally.

But as parents, we need to prevent injuries that can turn a fun summer into a painful time or even a life-altering tragedy. Here are 6 ways to help your kids have an enjoyable summer season.

1.     Prevent Sunburn

These days, you’re probably aware of the hazards of too much sun exposure, especially for infants and children. But it never hurts to be reminded of a few tips to prevent painful sunburn or worse.

  • Keep children out of direct sunlight or cover them completely between 10:00am and 4:00pm when UV rays are strongest. Infants under 6 months of age should avoid all sun exposure.
  • If children play outside during midday, apply a sunscreen with SPF strength of 30 or higher at least 15-30 minutes before sun exposure and have them wear protective clothing (wide-brimmed hats, sun-protective clothing that covers arms and legs, and sunglasses with UV protection).
  • For children playing in water, apply a water-resistant sunscreen every 2-3 hours.
  • If both sunscreen and insect repellant are required, apply the sunscreen first and then apply the insect repellant. Do not use a combination product.
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To treat a mild sunburn at home, try applying cool cloths or taking cool showers. Lotions containing aloe vera can help ease pain. Acetaminophen (Tylenol™) can help soothe a headache. It is also important to drink water to prevent or relieve dehydration. Avoid using topical steroids on young children unless directed by a physician.

More extreme sunburns that involve blistering, high fever, severe headache, dehydration, confusion, or nausea require the sort of medical attention that urgent care centers provide.

2.     Police the Playground and the Beach

 

Playgrounds and beaches provide places for good exercise and lots of fun. They can also be dangerous.

Make sure that your favorite playground has well-maintained equipment. Rusty metal equipment can lead to metal splinters and nasty infections. Untreated wooden equipment can produce splinters and unpleasant scrapes. Loose bolts are accidents waiting to happen. You might also check for poisonous plants such as poison ivy and infestations of bees or other pests.

Beaches are always a favorite with kids, but you should be aware of potential hazards. It goes without saying that you should always watch children in the water. Water depth and wave action can change rapidly. Also watch out for various critters—jellyfish, sea urchins, sting rays, even sharks—that can injure unsuspecting children and adults. Remember that the water and beach are these animals’ primary habitat, not yours. Medical attention might be needed for stings and bites.

A word about trampolines. If you’re thinking of getting one for your home, don’t. Citing nearly 100,000 injuries per year, the American Academy of Pediatrics discourages recreational trampoline use for the home, even when all the safety rules (listed below) are followed. Kids are often injured when bumping into others, trying stunts like somersaulting, falling or jumping off the trampoline, or just landing wrong. Very serious and sometimes life-threatening injuries result, including broken bones, concussions, neck and spinal cord injuries that can lead to paralysis or even death.

If you already have and use a trampoline at home, follow these rules:

  • Allow only one jumper at a time.
  • Do not allow stunts, especially somersaults.
  • Adults who are willing and able to enforce safety rules must supervise at all times.
  • Make sure that safety netting and padding is in place and maintained.
  • Check your homeowner’s insurance policy to make sure that you’re covered for trampoline-related injuries.

3.     Avoid Insect Bites and Stings

 

Insect bites and stings can interrupt summer fun. Ticks are plentiful this year, and they carry debilitating, sometimes lethal, diseases [insert link to blog post on ticks]. Always check for ticks on anyone who has been outside, and remove them immediately. Using an insect repellant with at least 20% DEET can help.

Insect repellants are usually effective to keep mosquitoes in check. An occasional mosquito bite is seldom cause for concern, but being covered by mosquito bites will ruin any hike or camping trip in short order.

Bee and wasp stings can be dangerous, especially for persons who are allergic to them. For anyone who is allergic and at risk of anaphylactic shock, take the following steps:

  • Call 911.
  • Use an EpiPen™ to inject epinephrine into outer muscle of the thigh, not into hands or feet.
  • Go to an urgent care facility or emergency room immediately after an EpiPen™ injection, even if symptoms subside, since there can be a delayed allergic reaction.

If there are no symptoms of allergic reaction, do the following:

  • Remove the stinger by scraping with a flat edge. Do not pinch or use tweezers since that will inject more poison.
  • Apply ice or cold compress.
  • If stung on an arm or leg, elevate the area.
  • Take acetaminophen (Tylenol™) for pain or an antihistamine (Benadryl™) for itching. Do not use aspirin.
  • Follow up with a visit to an urgent care facility in 2-5 days if necessary.

If you have any questions or concerns after a bee sting, call or visit an urgent care center.

4.     Patch Up Those Cuts and Scrapes

Most minor cuts and scrapes can be treated at home. However, if the wound is deep, dirty, or caused by an animal, a tetanus shot (or booster) might be needed.

Remember the following steps:

  • Wash your hands.
  • If bleeding doesn’t stop, apply pressure with a clean bandage for a few minutes.
  • Clean the wound with clear water. Do not get soap or other cleansers into the wound, but use them as necessary to clean around the wound.
  • If any debris remains in the wound, try removing it with (disinfected) tweezers. If you cannot remove the debris, go to an urgent care facility.
  • Apply an antibiotic cream and cover the wound with a sterile bandage.
  • Change the bandage once a day or if it gets wet.
  • After the wound scabs over, stop applying the bandage.

It’s always a good idea to keep a well-stocked first aid kit handy for these situations.

Deep cuts or wounds that won’t stop bleeding might require stitches. Visit an urgent care facility for that sort of treatment.

5.     Attend to Head Injuries, Sprains, and Fractures

Bumps on the head are common for children and usually do not require medical attention. Nevertheless, if the following symptoms occur, you should go to an urgent care facility:

  • Unconsciousness, confusion, or disorientation.
  • Vomiting.
  • Persistent, severe headache.
  • Persistent irritability.
  • Memory loss.
  • Visual impairment.

If severe head trauma has occurred (immediate loss of consciousness; severe bleeding from head, nose, or ears; weakness in arm or leg; loss of balance, slurred speech, seizures, repeated vomiting, persistent crying, or cessation of breathing), CALL 911. Keep the victim still, lying down, and quiet. Do not move the victim unless absolutely necessary to get the victim out of further harm’s way. To avoid further spinal injury, do not move the neck. If the victim is wearing a helmet, leave it in place.

Sprains and fractures are sometimes difficult to distinguish. If your child merely rolled an ankle, then it might be a mild sprain. In such cases, the child might be able to put weight on the ankle, although sometimes there can be impressive swelling and pain. Rest, ice, and elevation will generally produce a good result in a few days.

P – Protect
R – Rest
I –  Ice
C – Ice
E – Elevation

If, however, there is major swelling, pain, numbness, or if it is extremely difficult for the ankle to bear any weight, a break might have occurred. Broken ankles, wrists, or other bones always require medical attention. Bear in mind that severe sprains can take longer to heal than some fractures.

Because it is difficult to tell a broken bone from a severe sprain, don’t take any chances. Go to your nearest urgent care center to get a professional diagnosis. Most have X-ray equipment on site and are prepared to treat broken bones and sprains.

6.     Keep Allergies in Check

During the summer, the weeds and grasses that developed during the spring continue to spread pollen that causes allergic reactions in children and adults. Sometimes, over-the-counter antihistamines such as Zyrtec™ can control these reactions.

But often, allergic reactions to pollen or molds can be truly debilitating with the potential to ruin a summer of fun. If you or your child suffer from seasonal allergies, ask a health professional to evaluate the situation. They can offer tips and medications that will help you avoid a summer filled with sniffles and runny eyes.

For all of these situations and if you are located near us, call or come to Kathy’s Urgent Care so that we can help you and your children enjoy a fun summer. Remember, we’re here to help you 7 days a week. No appointment needed!

Authored by Dr. Tom Brown

Ticks Can Make You Sick!

Because of the larger number of active ticks throughout the US, tick-borne diseases are on the rise. A warm, moist spring caused adult ticks to become active in April which is much earlier than normal. If you or your family spend time outside in the woods, your lawn, or around bushes and other foliage, you are at risk. More on prevention below, but first some information about ticks and the diseases that they carry.

 

How Ticks Infect People and Pets

There are several varieties of ticks, and they all carry specific diseases. The blacklegged tick or “deer tick” (pictured here) carries Lyme disease, Powassan virus (POW), and other diseases. It is especially common in New England. Other varieties of ticks can infect people with Rocky Mountain Spotted Fever (RMSF), a serious disease that is sometimes fatal.

Ticks spread various bacteria and viruses by injecting them into humans and animals when feeding. Typically, this happens when an adult tick attaches its head and begins to ingest blood. Since a mild anesthetic is also injected into the bite, people often feel nothing.

How to Prevent Tick Bites

For people, there are three major ways to prevent tick bites and infection.

1.     Wear protective clothing, including long-sleeved shirts and long pants with the legs tucked into socks. Closed footwear is essential. Do not wear shorts and flip-flops into the woods or grass!
2.     Whenever you go outside or into wooded areas, consider using an insect repellent with at least 20% DEET, picaridin, or IR3535 formula. Also treat clothing and gear with a product containing 0.5% permethrin. Permethrin remains effective through several washings. For help in selecting effective products for you and your family, use the Environmental Protection Agency (EPA) tool.
3.     Examine every part of your body as soon as you return indoors. Ticks can attach themselves to any area of your body: under arms, in your hair, between your legs (crotch area), in your belly button, and other nooks and crannies. Ask relatives or friends to help you check areas that you cannot see. Don’t be bashful about this! Also remember to check the bodies of your children thoroughly.

You should also thoroughly check any pet, dog or cat, that has been outside. Check every time they come in. Ticks often burrow into an animal’s fur, making them hard to see. Once a tick gets into your home, it can then transfer to people. Medications are available that prevent ticks from hosting on dogs or cats, and they generally work. But be careful, since some medications that work for dogs are toxic to cats.

Tick Removal

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Remove ticks as soon as you discover them. The best way is to grasp the tick as close to the head as possible with tweezers and lift straight up.

If you need assistance with removing a tick or if your attempt is unsuccessful, come to Kathy’s Urgent Care. We’ll be happy to help you and to answer your questions.

Medical Risks

Lyme Disease: Infection can occur within 24 to 48 hours of a tick’s being attached to your body. Symptoms can appear from 3 to 30 days after a tick bite. Common symptoms include a distinctive rash, weakness of facial muscles, and swollen or painful joints, particularly if fatigue and low-grade fever are also present.

Accurate diagnosis of Lyme disease sometimes requires a blood test. Do not self-diagnose! If you think that you or a family member has been infected, be sure to check with us to have the blood test performed if necessary and so that treatment can begin.

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It is important to begin treatment as soon as a diagnosis can be confirmed. Lyme disease can have very serious and long-term consequences.

Powassan virus (POW): Infection can occur within 15 minutes of a tick’s bite. Early symptoms can appear within 1 week to 1 month. Symptoms can include fever, headache, vomiting, weakness, confusion, loss of coordination, speech difficulties, and seizures. Unfortunately, many people who are infected exhibit no early symptoms, making detection very difficult. This is why prevention of tick bites is so important.

The POW virus can infect the central nervous system, causing encephalitis or meningitis. There is no known cure and no vaccines or medications to prevent or treat infection. About half of those infected with POW develop permanent neurological problems such as headaches, memory problems, or muscle weakness.

Conclusion

If you think that you or a family member has been bitten by a tick or if you need assistance in removing a tick, come to Kathy’s Urgent Care or other medical facility. Time can be important, and we’re open 7 days a week!

Enjoy your summer, but be careful!

Authored by Dr. Tom Brown

The following links can provide additional information: