Head Injury Awareness: Signs, Symptoms, and What to Do After a Crash

0:00:06 - Shane Smith Hey, I'm Shane from Shane Smith Law. I'm here today with John, one of the attorneys here at Shane Smith Law, in the Brain and Concussion Injury Group here. This is an episode of Mind Matters Navigating Head Injuries and Concussions. If you like this kind of podcast, please hit the bell for notifications and like and subscribe. John, today we're going to talk about symptoms and injuries right after a car accident, right? Specifically those injuries as they relate to the head. What's the most common injury? What comes up the most?

0:00:31 - John Mobley Absolutely, Shane. So you know that's going to be our discussion today about the immediate concussion symptoms. A lot of times we see dizziness, we see nausea, just the client not understanding what's going on, where they are. These are some of the main ones that we see.

0:00:48 - Shane Smith So, John, when I think of a concussion in a car accident, I'm always thinking about the person who blacks out, who hits their head and is totally unconscious. Is that all that common, or are there other stuff that happens a whole lot as well?

0:01:00 - John Mobley You know that is one of the possible outcomes, Shane, but it is, it's actually a more rare outcome. There are so many different shades of gray, if you will, and different types of brain injuries along the spectrum, but the more common ones we see, or is typically where the client appears almost disoriented, drunk sometimes is how their family and friends describe their loved one who sustained some degree of a concussion, and just being kind of all over the place. There's, of course, the Glasgow Coma Scale, where you know if you are completely blacked out and non-responsive, that's typically very bad, but there's a whole other level and the vast majority of these head injuries usually result in lesser kind of outcomes than a full blackout. Not being non-responsive, usually it's more like they're disoriented, and even sometimes they may even be talking to the EMS personnel or first responders and then days later just not even remember that they were having conversations. Really.

0:02:00 - Shane Smith So I was going to say so let's break those down a little bit. So to me, when I, when you tell me somebody who's disoriented so much they appear drunk, that seems frightening that they hit their head hard enough that I guess things are all jumbled up right, how can friends and family sort of identify that what would tip, tip the hat, that, hey, they're probably not drunk, they probably hit their head or something else. I mean, is there anything that would key them into that?

0:02:22 - John Mobley Yeah, absolutely, and that's why the range of outcomes vary so much. When someone initially gets into the accident I mean if they're with a family member that knows them well, that family member is going to say, you know, wow, something's off here. Yeah, you know you're saying and doing things you don't normally do. But if you're in the car, maybe in the backseat and you get rear-ended of an Uber, the Uber driver might not know if that's you or if that's someone else. So same goes with the first responders. Sometimes they don't adequately assess the degree of the head injury because as well as maybe a family member could, knowing that they were in an accident, that where they hit their head, and that's just simply because it can be very nuanced and and the person's change in their personality is only something that a close friend or family member would recognize.

0:03:12 - Shane Smith So we would certainly say if you've been in a car accident, certainly a serious car accident, but a car accident, and friends and family afterwards are like, hey, this seems a little odd, even if they've been checked out by a first responder. What should they do? Would they take them to the hospital? Would they take them to their doctor, what, what, what should they do if it seems weird?

0:03:31 - John Mobley Absolutely. If you suspect any degree of a concussion or head injury, you absolutely need to at the very least, go and see some level of a medical professional, whether that's an urgent care or a ER, so that you can do the followup diagnostic tests and be cleared by a true specialist.

0:03:53 - Shane Smith So the fact that a first responder shined the light in your face and moved on, that's not a good indicator that there was no head injury at all, is there?

0:04:01 - John Mobley No, the only real assessment, unless it's completely evident to the EMS like you have a skull fracture, the only real assessment they're doing is usually the Glasgow Coma Scale, which is going to assess the injured person's responsiveness level so that they can gauge how bad is this. But the real kind of specific diagnosis are gonna occur later at the medical facility and that's gonna be done by an ER doctor or a neurologist through things like the clinical evaluation of the client, a CT scan, later maybe a brain MRI or having an actual neurologist come in.

0:04:38 - Shane Smith What is sort of the- when we talk about immediate injuries, right, what is sort of that time period when friends and family would notice something is off a little bit? Is that like right after the accident? Is it like two, three days? Is it like a week? What's the most common area in where I'm looking for immediate symptoms?

0:04:56 - John Mobley Absolutely so. It's usually directly following the impact. Okay, and when that brain either hits the steering wheel or the inside of your own skull or the back of the headrest, when you're coming back in that hard whiplash fashion, that can be so fast and so immediate that sometimes people don't even know they hit their head.

0:05:18 - Shane Smith So they're not looking for the cracked windshield kind of deal, or the cracked side glass, I guess. I mean, there's so many things in the car you can hit your head on. Yeah, absolutely, and that headrest is not gonna be soft enough to fix the issue.

0:05:26 - John Mobley Unfortunately not. The technology is not yet there that, that head hitting the back of that soft cushion seat is enough to still cause a concussion and a mild brain injury.

0:05:37 - Shane Smith And when you talk about headrest, you know behind, you're actually supposed to put those a certain specific way as well for them to be effective. And I don't know, when I'm getting in cars I don't generally move the headrest around for myself, I just get in and ride.

0:05:51 - John Mobley Right, I do the same thing.

0:05:54 - Shane Smith So that's clearly another issue that exacerbates this problem. What I wanted to ask is you said sometimes you know the EMTs, first responders, they're checking them out and they think the person's totally fine, and is that just because they don't know the person? Is that what it is, or is it because that gap in memory and stuff just hasn't shown up yet, or what's going on with the person?

0:06:13 - John Mobley Right, that's not like a full brain injury assessment that's occurring immediately at the scene. It's really just to assess is this person living or potentially on the way to not be not living? It's really kind of a more of emergency triage type thing. And so that's why it's so important to get to a doctor. And you asked previously you know what can you do in that initial phase. There's gonna be some big indicators. Sometimes we see our clients talking about nausea. Some actually vomit at the scene. That's a classic brain injury symptom.

0:06:44 - Shane Smith So if that happens, definitely.

0:06:46 - John Mobley Clear as day. You need to go to the doctor immediately, probably to the ER, and those symptoms that family members can pick up on you know those will last, sometimes for minutes to hours, and then, depending on the severity of the brain injury, they will resolve. So that's why it's so important to kind of, we find out what happened at the scene. A lot of times, as an attorney, we'll look at the EMS record, because they're the first people there. And you know if we don't have any witnesses, that's sometimes the best information we have, and we'll see that a lot of times. The EMS personnel will give great notes as to what they noticed. Was the person not making sense? Were they not able to answer questions? You know like what day is it? Who's our president? You see these questions a lot by EMS. Right yeah, like just the basic stuff. Those are such valuable, valuable notes, because sometimes that stuff improves quickly with a client and then we just may never know that they did sustain a head injury until later it comes up. You know, maybe weeks later they still have the sensitivity to light, they still have the headaches, they still have irritability and are forgetting things. And we don't necessarily see it because of their either no witnesses or it wasn't documented by the EMS.

0:07:56 - Shane Smith Because of the fact that I had nausea or dizziness at the time, but it got better by the time, say, my wife got to the scene two hours later. That doesn't mean there was no head injury.

0:08:12 - John Mobley Right. It can happen that quickly, sometimes, where the symptoms improve, and sometimes, depending if it's a bad injury, then it can go on for days and days.

0:08:20 - Shane Smith But just because it gets better it doesn't mean I'm all better really.

0:08:24 - John Mobley Absolutely not. Unfortunately, once a brain injury has occurred, the studies are pretty clear on the fact that there is no cure, unfortunately. There's treatment, there's rehabilitation, there's ways that you can change your life, but if you in fact did sustain a brain injury, it can develop into a progressive disease, neurodegeneration, usually not good. Now there's of course, various degrees of them, from mild to severe, but once they occur, they're there. And is a concussion the same as a brain injury? Yes, a concussion is a form of a brain injury.

0:08:58 - Shane Smith So that's just so, if they say you have a concussion, you've had a brain injury of some type, correct, it's just where is it on the spectrum?

0:09:04 - John Mobley Exactly a concussion, and the later post concussion, post concussion syndrome, you know a brain injury from mild to moderate, to severe or traumatic. It's just kind of how they classify the progression of the brain injury disease.

0:09:21 - Shane Smith I mean, but the severe and traumatic, those are the ones we see on TV kind of deal, but we don't see a lot of people talking about the mild and the moderate kind of deal. It can still impact your life significantly right?

0:09:33 - John Mobley Just as much of an impact, yeah. And the movies and TV and Hollywood, a lot of times it's a person has hit their head catastrophic and they're in a coma or need to learn how to walk again. We certainly see those. But there is a whole nother world of brain injury out there where it is just as long of a battle and lifetime challenge for our clients who have sustained some of these mild and moderate brain injuries.

0:09:56 - Shane Smith And one of the things I've seen with the mild and moderate people is they've got the symptomology. You know that stuff happened in the beginning. They have symptomology that continues on and they start to doubt whether it's real or not or whether it's them it's all in their head, kind of deal. Is there anything that can help with that?

0:10:11 - John Mobley Absolutely so. You know we've come such a long way with how we diagnose and assess these things. We're now seeing blood tests, where some of brain injury breakdowns and the hormonal stuff go on actually produces what's called markers in the blood that can be tested through blood tests. Brain imaging has come and advanced, you know, light years since just being able to get a CT scan back in the day. Now we have other things called DTIs, which can really map the flow of water in the brain to see where the injury occurred and create a 3D model. We've also seen improvements with a neuropsychologist and how they assess brain injuries through very rigorous battery of cognitive testing.

0:10:54 - Shane Smith Yeah, you mentioned a blood test. Can my primary care doctor just order that?

0:10:59 - John Mobley You would have to check. I'm not sure. It's relatively new. It's the newer of all the big brain tests, so we're kind of seeing of how wide scale the usage is of it. But it's proven to be very reliable.

0:11:10 - Shane Smith If I think my family members showing symptoms of this, some kind of brain injury. What do I need to do?

0:11:16 - John Mobley You absolutely need to encourage them to go and see a doctor at the very least, and to follow up with a specialist too. Because we have to remember, just like the EMS's main job is to get you alive to the doctor, the ER's job is really to triage people that are in severe, severe, experiencing severe issues. So, sometimes the ER will miss certain brain injury markers as well. They'll just do a CT scan and then recommend you follow up to your neurologist. It's usually way down at the sheet they give you that says go see the neurologist, please, please. I stress to anyone listening out there if you're told to go and see a neurologist, please do it.

0:11:55 - Shane Smith Go see the neurologist, go see your family doctor, get in to see the specialist, right?

0:11:59 - John Mobley I would say it's almost five to six times out of 10 with our clients, we see where they were told, given what they thought was a pretty clean bill of health from the ER, and then we get them with the neurologist, and the neurologist is like you are nowhere near from being out of the woods yet. Unfortunately, we have a bunch of other tests to do and they suspect a brain injury did in fact occur. And you also mentioned what family members can do. You know, on the problem side is there was, you know, recently comedian from Full House, Bob Saget they're now suspecting sustained a fall in his hotel and went to bed instead of seeking treatment, and they think that is- you know this is it's still being investigated, but that is the current leading theory as to how he passed away, cause he went to sleep instead of seeking care at an urgent care or an ER. And you know that can happen. That's why the doctors will always recommend if you suspect a brain injury, please get checked out.

0:12:53 - Shane Smith And I've seen stuff in movies where somebody has a concussion like don't let them sleep or check on every 30 minutes. Is that kind of what they're worried about?

0:13:00 - John Mobley Yeah, that's the standard thing. If you have a slow to moderate brain bleed or hematoma, it can progress fast and you can be in trouble fast.

0:13:11 - Shane Smith All right, John, I want to thank you for coming on Mind Matters. I know you work on a lot of brain injury and concussion clients and help them out and I think your knowledge is always helpful to them and make sure they get the right care they need. For our listeners, if you're interested in concussions and brain injuries, hit like and subscribe and remember to hit the bell for notifications and remember if you're in pain, call Shane at 980-999-9999. If you think a family member has a brain injury or a concussion from an accident, John would be a great person to help you.