What kind of doctor should I see?

[MCS]

I was recently in a car wreck where the car hit a tree moving backwards at a high speed. My head hit the headrest pretty hard. I have no significant pain, but I think I should go see a doctor anyway.

What kind should I see? Is internal medicine or general practitioner appropriate and sufficient?

Thanks.

[flow void]

why see a doctor?

[CharlieDontSurf]

a shrink

[dizong]

[ QUOTE ]
I was recently in a car wreck where the car hit a tree moving backwards at a high speed. My head hit the headrest pretty hard. I have no significant pain, but I think I should go see a doctor anyway.

What kind should I see? Is internal medicine or general practitioner appropriate and sufficient?

Thanks.

[/ QUOTE ]

yes although if you have no discomfort, i don't think your doctor will order any tests, probably just provide reassurance

i'm not sure what the hell you were doing driving backwards so fast; were you playing tug-of-war with your car?

[cbloom]

WTF, don't see a doctor, you wuss.

[Hawklet]

OB GYN?

[MCS]

[ QUOTE ]
yes although if you have no discomfort, i don't think your doctor will order any tests, probably just provide reassurance

[/ QUOTE ]

I suspect that as well. I did have soreness in the back of my neck the morning after, but it's gone now. I just think it's +EV to get checked out anyway.


[ QUOTE ]
i'm not sure what the hell you were doing driving backwards so fast; were you playing tug-of-war with your car?

[/ QUOTE ]

I may be getting leveled here, but in case I'm not: I spun out in the rain while going like 70.

[dinopoker]

Next time tell the driver to leave a two second gap between you and the tree.

And go see a GP, he'll refer you to the right kind of specialist.

[brashbrother]

I am family medicine doc. I see stuff like this often. Couple quick questions and a brief exam, and about 95% of the time, I would tell you what you already assume: muscle stiffness and soreness (aka whiplash), it will get better in several days, maybe a week or so.

The reason I get paid to tell you that is to make SURE you are not in the other 5%, where you might have done some damage and could need either some treatment/physical therapy or possibly some imaging (CT or MRI) to assess for the bad stuff.

Long story short, for your own reassurance, go see your family doc. If you have insurance, this should be a no-brainer. If not, figure the cost of going vs. the cost of wondering, everybody has their price...

[hobbes9324]

This comes up every month or so...I cut and pasted my last response...hope it helps.

MM MD

Everything you ever wanted to know about head injuries, but were afraid to ask...Cliff notes for OP at bottom.

There is a fairly safe decision tree that we follow in our ED for patients with head injuries - the question is basically "does this guy need a head CT, or not."

Generally, you should be scanned if you present with a head bonk and any of the following -

1) Loss of consciousness - some say for any period of time, some are willing to tolerate a brief (say 30 second) LOC. Note that we're talking stone-cold out - not dazed, stunned, or goofy - OUT.

2) If you're a hard core alcoholic - your brain shrinks, and bridging veins that run between the brain and the skull are swaying in the breeze, and more likely to tear.

3) If you're over 60 years of age, for the same reason.

4) If you're on a blood thinner called coumadin, which is basically rat poison - patients on this medicine frequently bleed with NO trauma, so we are cautious with them. A lot of docs are pretty cautious with patients on plavix, also, but all the returns aren't in yet.

5) Patients with a focal neurologic finding - loss of vision, inability to speak, loss of function in an arm or a leg. For both type four and five patients, they frequently have a spontaneous bleed that results in a fall and head bonk, rather than a head bonk causing a bleed. It matters to the neurosurgon, to some degree - for the patient, not so much, as they're likely going going to the OR anyway.

6) Kids under 6 with large scalp hematomas need scans, but you probably don't fit in that group.

7)Persistant vomiting - most ER docs, in my experience, use the "three pukes and you're scanned" theory.

8) Open skull fracture - brains on table is bad.

9) Basilar skull fracture - usually diagnosed by the MD seeing blood behind one or both ear drums. While the skull fracture itself is pretty much trivial, the amount of force needed to give you one often also causes significant brain injuries.

10) Persistant headache - more than 90 minutes or so after the accident - MAY have some slight predictive value for patients who will have delayed bleeding. Or not. The data's not all in yet.

Barring all of the above, you almost certainly don't have a brain bleed. You may well have a concussion, but generally the treatment is pain medicine, sympathy and avoiding more head bonks. Not that you couldn't wake up dead in the morning, of course.......

Fun facts -

Skull films (plain x-rays) for trauma are pretty much not done any more - and a lot of authorities feel that ordering them is likely malpractice.

The theory behind waking up someone with a head injure predates CT scanning. The theory was that a patient with an epidural bleed would be hard to wake up, and you could rush them back to the hospital so the MD could drill a hole in their skull and relieve the pressure. Let's say the success rate was not so good. The good news nowadays is that if your CT is negative, you (and your family) get to sleep thru the nite.....

MM MD