Is he gonna die?

August 30, 2008 7:48 PM

What's the difference between a concussion and drunk? Is he going to die? (OK not really—but is it safe for us to go to sleep?)

My boyfriend (owner of this account) got into a minor fight earlier tonight. His head was slammed against the wall. He's also a wee bit drunk—this may have had to do with head getting slammed. We're both really tired, but I'm terrified that if I let him go to sleep he'll go into a coma because he has a concussion. We just called the doctor on-call from his health clinic but she just said "You can talk to me coherently so that's a good sign, but if you're concerned go to the ER."

The question is: How can we tell the difference between stupid-drunk and stupid-concussion. The doctor was totally dismissive when we tried to get her to elucidate the difference.

Can we go to sleep? Help.

posted by cheerwine to health & fitness (23 comments total)

Wake him up and look at his pupils. As long as both his eyes look the same, and he is able to wake up when you try to wake him up, he's probably fine. Go to sleep. Good luck. I'm not a doctor though, so you may want to follow somebody else's advice.
posted by mamaraks at 7:55 PM on August 30, 2008

Go to the ER. The internets can wait.
posted by Inspector.Gadget at 7:56 PM on August 30, 2008 [1 favorite]

Wikipedia's thoughts on diagnosis. The standard thing I always see done in sporting contexts is shining a flashlight in the subject's eyes to see if they dialate properly, asking them things like their mother's name and what year it is, asking them to track your finger with their eyes, etc.

If you see anything amiss, I'd go to the ER in this case.
posted by phrontist at 7:58 PM on August 30, 2008

I should note: there's no way I'm getting him to the ER unless I have good evidence he's going to die. I mean that pretty literally—he hates hospitals and I can't physically drag him to one.
posted by cheerwine at 8:00 PM on August 30, 2008

Lie.
posted by phrontist at 8:01 PM on August 30, 2008

phrontist has a good idea

>unless I have good evidence he's going to die

Your first evidence might be: he dies.

A head injury can cause symptoms within twenty minutes or within twenty hours.

"Better safe than sorry" has a ring of truth.
posted by megatherium at 8:12 PM on August 30, 2008 [3 favorites]

If you're truly concerned, I'd call for an ambulance. The EMTs will evaluate him, but will likely suggest going to the hospital just to be safe. If you can't convince him to do this, the EMTs and PD certainly can.
posted by blaneyphoto at 8:13 PM on August 30, 2008

Yes, he might die. He had his head slammed against a wall ... sometimes, without medical attention, head injury results in sudden death. Nobody at Metafilter can really know whether he is going to die, but yes, he might.
posted by jayder at 8:14 PM on August 30, 2008 [1 favorite]

You don't say how long it's been since it happened, or really given much in the way of details, but you need to go to the ER. You can't tell whether he's drunk or bleeding into his head, but a CT scan can.

Mamaraks point about the pupils is a popular misconception. Pupils start being asymetrical when you've got so much blood in your head that your brain is herniating downwards. By the time you have asymetrical pupils, it's time to call a neurosurgeon to cut open your skull.

What I would be concerned about here is an epidural hematoma. These classically happen after trauma to the head, and they are associated with a so-called "lucid interval," in which the victim seems to be relatively okay, is awake, can talk, etc. However, there is blood collecting under the skull, with potentially fatal consequences.

I don't know if your boyfriend has this or just a bump on the head. But I know that a night wasted in the ER is considerably better than messing about with a potentially serious head injury.
posted by LittleMissCranky at 8:18 PM on August 30, 2008 [2 favorites]

Also, everyone hates hospitals. That doesn't give you any special exemption from dying.
posted by LittleMissCranky at 8:27 PM on August 30, 2008 [10 favorites]

IMNAD, nor do I have any medical training, but I worked with an organization that dealt with brain injuries (I was a data geek). Sports clichés (clock cleaned, bell rung, etc.) aside, there's really no such thing as a mild concussion. Concussions can have minor or major consequences, including death, and while more serious whacks to the head usually have the more serious consequences, it's not entirely predictable and all concussions should have a medical assessment. Not all doctors have training in assessing "mild" brain injuries, which might account for the on-call doc's comments. What appears to be a mild injury can have life-altering results. Get your BF to the ER.

Good luck to you both, and I hope he comes through this with nothing more than a bump and a hangover.
posted by angiep at 8:32 PM on August 30, 2008

How can we tell the difference between stupid-drunk and stupid-concussion.

The bottom line is that it is nearly impossible to do so. If it clears up by the next morning it was drunk. I nearly always admit people for observation in this situation if I think the head whack was severe enough to have a possibility of producing cerebral edema.

Then again, a head whack has to be pretty severe for that to happen. Hard to tell from here.

At the L.A. County Hospital where I trained this presentation is called BHT for 'blunt head trauma,' but everyone actually just calls them 'drunk head whacks.' It always seemed to me to be like a game to see which service will have to accept the drunk head whack from the E/R. Does this drunk head whack have kidney trouble? He goes to the Renal service. Cirrhosis? GI/Liver. A facial laceration? The unfortunate intern on plastic surgery has to detox the guy. The neurosurgeons I knew were very bitter about having to accept more than they felt was their fair share of drunk head whacks.

Pupil inequality is certainly bad after head trauma, but it is not the only bad thing that happens, nor does it always happen, nor does it always show itself in a timely way to prevent further problems, nor is someone always looking at the pupils when it manifests.

With due respect to the guy who posted

As long as both his eyes look the same, and he is able to wake up when you try to wake him up, he's probably fine.

I would point out that neurology is not a home game and the consequences of being wrong can be disastrous.
posted by ikkyu2 at 8:33 PM on August 30, 2008 [11 favorites]

IANAD, obviously.

Signs he has increasing intracranial pressure (this would be a really bad head injury; if he has these, it's serious, and if he doesn't it might still be serious):

-Lots of vomiting. Bad vomiting. Projectile vomiting.
-An unbearable, debilitating headache.
-Changes in mental status (ie, he goes from fully alert to being only verbally responsive, or from being verbally responsive to only being pain responsive.

If it's a run-of-the-mill concussion, it's not good, but you [probably] don't need to go to the emergency room. He should definitely be monitored for 24 hours regardless of how he feels.

You have to use your judgment, but personally my thought is that a really nasty knock on the head is just that--a really nasty knock on the head. It happens all the time, and unless you have some reason to worry about his spine (doesn't sound like it), or he has any of the symptoms above, then you're looking at a headache or a concussion (bad, but certainly not about to kill him). There's not a lot a hospital is going to do for someone with a concussion other than lay them down on a bed (maybe give him an IV or something...)
posted by Autarky at 8:43 PM on August 30, 2008

How can we tell the difference between stupid-drunk and stupid-concussion.

By having him examined by a trained medical professional. Which we, ikkyu2 excepted, are not.
posted by dirtynumbangelboy at 8:47 PM on August 30, 2008

WFR here, like an EMT only cooler. I should add that ICP (increasing cranial pressure) can have the signs that autarky has listed, or it can have none.

There are plenty of people who made a tiny tear into the lining of the brain and took hours if not days to bleed out. Asleep and drunk you have NO IDEA OF HIS MENTAL STATE.

Alcohol will also thin his blood, theoretically exacerbating any injury he might have.

Stop waiting for responses here, throw his ignorant belligerent ass in the car, and take him to the ER.

I'd give you all kinds of metrics to test his status IF HE WASN'T DRUNK, but in this case DRUNK = FAIL.

I mean, really, you've got two options. He's fine and you give him shit about it for a week, or he's a statistic and a story in the paper and you're out one boyfriend.

If nothing else, the bill might be the smack in the face he needs to realize that Drunk + Fighting= Fail.
posted by TomMelee at 8:56 PM on August 30, 2008

"WFR here, like an EMT only cooler."

For those who don't know, WFR = Wilderness First Responder.


I am a former WFR, currently a Wilderness Emergency Medical Technician.
posted by blaneyphoto at 9:10 PM on August 30, 2008

"Stop waiting for responses here, throw his ignorant belligerent ass in the car, and take him to the ER." Unless Cheerwine's SO has been drinking as well, right? - hence my suggestion to call the ambulance.
posted by blaneyphoto at 9:18 PM on August 30, 2008

Heh, good point blaney...if you've been drinking don't drive. (/me wants my wemt, looking for a reason to get my NPO to pay for it.)
posted by TomMelee at 9:19 PM on August 30, 2008

Here's the free clue:

You are asking random people on the Internet whether your boyfriend, who has recently experienced head trauma, whether he is injured enough to die.

You are asking random people on the Internet whether your boyfriend, who has recently experienced head trauma, whether he is injured enough to die.

The ER has experts in the field, trained for years on such things. You are asking random people on the Internet whether your boyfriend, who has recently experienced head trauma, whether he is injured enough to die.

If my LARGE, PULSATING CLUE is not enough to get you and him to go to the ER...
posted by dirigibleman at 10:24 PM on August 30, 2008

ER now.
posted by arimathea at 10:37 PM on August 30, 2008

...he hates hospitals...

He's hate being dead even more.

... and I can't physically drag him to one.

Yeah. If he was dead or in a coma it would make it a lot simpler to drag him somewhere.

Listen, if you're afraid he might go into a coma if he falls asleep you get to a fucking hospital.

I hope the reason you haven't posted a followup is that you are there now. I hope you get good news.
posted by Ookseer at 10:38 PM on August 30, 2008

Please follow up.
posted by bilabial at 6:16 AM on August 31, 2008

Hi, I'm the drunk (now sobered up) boyfriend with the head injury. I'm alive! I continued o be stubborn and convinced my girlfriend (OP) to just let me go to sleep and wake me up occasionally. I'm pretty sure now that it was just a painful whack on the head with no concussion, but I'll be keeping an eye on any symptoms if they come up in the next day or so.
posted by cheerwine at 10:23 AM on August 31, 2008