Nurse’s Notes: Traumatic brain injury remains risk in winter

(Missoulian) The air has finally cleared and I no longer feel like I live in an ashtray. The fall colors, football and hunting will soon yield to the long nights of winter. Though summer is typically the busiest season for trauma centers (since so many people are out traveling and playing), the number of people suffering traumatic brain injury in winter is quite high.

Every year, according to Centers for Disease Control and Prevention statistics, an estimated 1.7 million people suffer a traumatic brain injury. Traumatic brain injury contributes to almost one-third of all injury-related deaths in the U.S. Many of these brain injuries lead to permanent disability or death, but about 75 percent are concussions or other mild forms.

What we have learned over the past few years about “minor” traumatic brain injuries is disturbing. Many people who have suffered brain injuries that are not serious enough to require hospitalization still have symptoms that can last for months. These can include headache, dizziness, irritability, sleep disorders and problems concentrating. In addition, they are at risk for life-threatening “second impact syndrome” which can occur after suffering a second blow to the head before the impact of the initial blow has had time to heal. The CDC has published return-to-play guidelines that can help with deciding when it’s OK to recreate or work again. These can be found at

The incidence of brain injuries caused by falls is increasing dramatically in our society, partly due to the aging of our population. Especially at risk for poor outcomes are those who strike their heads while taking anticoagulants (blood thinners). Even a minor blow to the head can be catastrophic for the person taking these medications. Health care providers frequently prescribe these medications for people at risk for stroke, and they work by decreasing the blood’s ability to clot. This can be a good thing if you have atrial fibrillation, but a bad thing if you fall on the ice and hit your head. If you hit your head and take a blood thinner, please be evaluated in the emergency department right away and tell them what medications you take. Decrease the incidence of winter falls by being considerate of your neighbors and keeping your sidewalk shoveled, by wearing only shoes or boots with good traction, by walking with short strides and eliminating sudden changes in direction, and by being cautious when walking on wet floors.

Winter recreationists can decrease their chances of suffering significant brain injuries by wearing a helmet. Skiers and snowboarders risk falling hard, slamming into trees or crashing into other out-of-control riders. The helmets made today are comfortable and quite warm. After wearing one for a few years, I think I’d feel naked without it.

I can’t talk about brain injuries without mentioning vehicular crashes. Please make sure your tires have good tread, your vehicle is in good working order (including wiper blades) and you drive appropriately for the conditions. Most importantly, slow down when the roads are slick!

Have fun this winter, but be careful and protect your brain. There are a lot of brain injuries we just can’t fix. You do want to be around to enjoy next summer, don’t you?