Field tests for a concussion?

[Amanita]

How might you tell if somebody has had a concussion or not, outside a hospital?

I'm working on a short story featuring some of the young skyscrapers of Dubai (See a previous post I made about a similar character, kind of like an urban dryad), and two of the young ladies get into it something like this, but with a little more martial arts training (Nothing fancy, but the enraged skyscraper-girl knows how to throw a better punch):
http://www.youtube.com/watch?v=XvijyBIgazE

I'm at the part where one of the adults breaks it up and is getting the rundown on what the hell just happened from everyone involved.

But I still have the would-be bully to deal with. She's taken some pretty good whacks. Skyscraper-incarnates are tough little creatures, but even they have their limits. So I'm going to have one of the adults do a bit of a damage assessment in situ, before deciding if little miss attitude needs to be taken to an ER.

What field tests might you do to see if somebody might have a concussion? And what symptoms would you tell them to look out for afterward, in case things get worse?

On another note, did you notice the bully's little toady in the video? One of bully-skyscraper's brothers suffers a similar fate, only it's more of a good solid punch than a shove. Is there any way of ascertaining whether somebody might have broken ribs or internal damage outside of an ER? And what might you tell somebody who's taken a punch like that to watch out for afterward, as a sign that either things are getting worse, or the damage was worse than suspected at first?

[fireheart]

IANAD, but I'd suggest looking through first-aid manuals, as they would give you some ideas of what to look for.

[Sapphire Silk]

Loss of consciousness, headache, mental status changes, nausea and vomiting are the usual signs.

[Argus]

The Real Life section of Non Sequitur Thud at TV tropes might give you some ideas.

[Flying Grype]

A little google bird gave me this: Survival Doctor - Do you have a concussion?

He makes a very good point that a lot of fiction writers miss, which is that symptoms of concussion don't necessarily show up immediately after the impact.

If your bully is not confused or dizzy or showing increased sensitivity to light five minutes after the fight, it doesn't mean she won't have a downturn sometime within the next few hours. If someone is in attendance who knows how to assess her for signs of concussion, they won't just take an initial look and then go "you're fine" and let her go on her merry way. They'd want to keep an eye on her for at least a few hours, if not days.

In other words, you may be able to detect concussion immediately if the symptoms are there, but it would be unrealistic (or it would depict irresponsibility) to have your characters dismiss the possibility of concussion immediately on the basis of a lack of symptoms. And as soon as she does start showing symptoms of any sort, a visit to the ER is in order. Or maybe even if she doesn't show symptoms. One thing that's being discovered especially in sports medicine is that lots of people who suffer impacts and are judged to be ok actually do have concussions, and they suffer ill effects down the road. So if there's a responsible adult around and an ER is available, they should go even if the girl is not showing symptoms. She's been in a bad fight, it's very likely that she's hurt.

I highly recommend the Little Details community on LJ. They have some rules about how to post; it's all in the community profile, but specifically try to find your answer in their archives before you ask a new question, and if you do ask a new question show them that you've at least tried to do your own research elsewhere. They don't want to answer questions that can be looked up anywhere. But they're a fantastic resource.

[Amanita]

That survival Doctor page is great, thanks!

The thing with my skyscraper-folk is that they're martial artists. For them, the need to learn self defense is even more pronounced than for many humans. In their incarnate forms, they are targets, likewise their original forms. The office towers may have to confront and/or take down a disgruntled employee or client who tries to whip out a gun in an office, or the main lobby. Or perhaps somebody trying to bring a bomb or other dangerous device in. (Imagine how different the first part of "Speed" would be, with a telepathic Skyscraper avatar confronting the bomber posing as elevator tech, instead of that poor security guard?)
A residential building or hotel also needs to learn how to deal with hostiles- non tenants showing up with the intention of harming a resident/guest, or even domestic incidents, where one person needs protecting from a violent other.

So this is a big thing for them, and they also learn first aid and the healing arts. Again, they may need to assist tenants in trouble, or help others of their own kind. That and spending time learning healing arts is a good shift in mental focus from "Let's hit things!"

So I imagine one of the adults would know the stuff mentioned on Survival Doctor, and would want to make sure that the girl got attention. I might have the older skyscraper offer to take her to the ER after doing his own assessment, upon which she answers. "Sure. Not like my super could be bothered", which might offer some insight as to where some of her attitude comes from.

[TheSHAD0W]

A bit of the science: Concussion occurs when a person's head hits an object (or vice-versa). The brain, which floats inside the skull, then hits the inside of the skull. This can cause the brain to be bruised.

Sometimes the bruising itself can be damaging or cause neurological symptoms; sometimes not. It does, however, usually cause swelling, and if the brain swells and presses against the inside of the skull, this can also cause damage and neurological symptoms. It may take time for the brain to swell, which is why onset of symptoms can be delayed. Pressure due to swelling may cause more damage and be more dangerous than the initial bruising.

Blood vessels can also be damaged in the impact, which results in blood accumulating inside or around the brain; these hematomas also can cause pressure on the brain.

[Amanita]

If anyone else is interested, I found this:
http://www.cdc.gov/concussion/headsu...s/SCAT%202.pdf

[RealUnimportant]

Regarding internal injuries or broken ribs: I broke a couple of ribs, and it caused pain on breathing as well as mobility issues, with the pain increasing if I lay down - which meant I had to sleep sat up for 2 weeks.

Depending on the severity of the internal damage, bruising could be very widespread in relation to the size of the initial impact site. Tenderness & a change in ... can't think of the right word, so I'll say sponginess/resilience of the internal organs when probed could also indicate damage.

IANAD, just going from how I've been treated in similar situations.

[dakhur]

Don't forget, injury can be relative to the persons pain threshold. I've had injuries that I've walked away with but other people can't handle, and vice-versa. What will give one person concussion will just give someone else a mild headache.