Waking advice

Introduction
You have just been to the Spoedeisende Hulp (Accident and Emergency) Department of Bronovo Hospital. The doctor decided that you (or your child) have had a concussion but that you do not need to stay in the hospital. You have probably been told what this means. In this leaflet, all the necessary information is set out for you.  

What is a concussion?
A concussion (commotio cerebri) is caused by a blow to the head, a fall or another violent impact to the skull. An injury to the skull does not necessarily lead to brain damage; most concussions do not result in damage or neurological changes to the brain.  

A feature of concussion is a short period of memory loss relating to what happened immediately before and after the accident. You may even have briefly lost consciousness. Other symptoms can be drowsiness, headache, nausea and vomiting and not knowing what happened and continuing to ask about it. The chance that complications can arise after a light concussion is very small but, if the level of consciousness decreases, this can be serious. This must often be dealt with at once. That is why it is so important that a close watch should be kept on the patient when he/she is at home. The instructions for care at home during the first 24 hours are given below.  

Waking advice (instructions for family or carer)
After the patient is at home, consciousness must be checked during the first 24 hours every 1   2   3   4   hours
This means that the patient must be woken up every ….  hour.
The patient must then be able to give a clear answer to any questions you ask. It is alright if the patient is not drowsy and is capable of carrying on a normal conversation.
Examples of questions you can ask:
Do you know what happened to you?
Do you know where you are now?
What day is it today? Which month? Which year?
What is your name? Where do you live? What is my name?  

Important
If the patient is asleep, he/she must be woken up and be able to give answers to simple questions. If, even though every effort has been made to wake the patient, he/she cannot be woken or appears drowsy, you must immediately contact your Family Doctor, the Spoedeisende Hulp (A & E) Department or telephone the Alarm Number 112.  

With the following problems, you must immediately contact the Spoedeisende Hulp (A & E) Department (also at night, in the evening and during the weekend).

• Increasing difficulty in waking the patient;
• Nausea or vomiting;
• Jerking/shaking (epileptic attack);
• Bloody or watery discharge from the nose or ear;
• Increasingly violent headache;
• Weakness or loss of feeling in the arms or legs.  

What else is important for home care (13 years and older)

• You must not take any sleeping pills nor must you drink any alcohol.
• You must not take any aspirin if you have a headache.
• Adult patients can take 4 – 6 Paracetamol tablets per day.
• Sometimes, you can feel sick. If so, the best thing to do is to eat easily-digestible food such as bouillon, rusks, grated apple or carrot and to drink tea.
• You can do what you like at home. There is no need to stay in bed but you should take things easy for the first few days.  

In any case, you should contact your Family doctor on the first working day after the accident. He/she will take over your further treatment. You have been given a letter for your Family Doctor which you should give to him/her.  

Waking advice for children
Babies can be given a drink after their nappy has been changed. Check that your child reacts as normal and make sure that he/she does not choke. If your child has a dummy, you can test his/her reaction when you take it out of his/her mouth.
If you cannot manage to wake your child, you can rub strongly under his/her foot. If your child is alert, he/she will not like this and react by crying.  

Toddlers and infants can be woken and taken to the toilet to urinate. You can then check how drowsy they are by observing how the child walks. Is that what you are used to seeing?
A cross or tearful reaction to being roused from sleep indicates that your child is alert. Try to give your child, in a sitting position, something to drink. If your child does not want a drink and can show this clearly, this is alright. If you have difficulty in waking your child, you can pinch a fingernail or earlobe. If your child is alert, he will dislike this and burst into tears.

Older children (up to 12 years) can be asked simple questions such as “What is your name?”, “Who am I?” or “What‘s the name of your Teddy Bear/cuddly toy?”. The right answer to such a question can reassure you that your child is not drowsy. If you cannot wake your child, you can pinch either a finger- nail or an earlobe. Your child reacts alertly to this if, for example, it says “Ow!” or bursts into tears.  

Conclusion
Should you have any further questions, having read this leaflet, please do not hesitate to contact the Spoedeisende Hulp (A & E) Department of Bronovo Hospital.
Telephone number: 070 - 312 44 45.