Snapshot A 33-year-old male is brought to the ED following a bike accident in which he was not wearing a helmet. He lost consciousness and after regaining consciousness had an episode of nausea and vomiting. Introduction Immediate transient impairment of neural function due to a jarring injury to the brain Loss of consciousness (LOC) is not required occurs in 10% Rule out associated neck injuries Prevention includes enforcing proper head gear minimizing premature return to play Presentation Symptoms transient LOC nausea and vomiting disorientation Evaluation Non-contrast head CT usually normal as seen in the Snap Shot rule out intracranial hemorrhage subdural hematoma most common epidural, subarachnoid, intracerebral bleeds also possible CT required if patient is unconscious for greater than 5 minutes indicated in all children with neurologic or bleeding disorders after head trauma Glasgow coma scale (GCS) score of 13-15 indicates mild traumatic brain injury score of 9-12 indicates moderate traumatic brain injury Neurologic and fundoscopic exam Differential Subdural hematoma, epidural hematoma, subarachnoid hemorrhage Treatment May need to intubate to control intracranial pressure hyperventiliation Discharge with observation if a CT scan is normal, mild-to-moderate brain injury can be discharged with instructions given to the caretaker to return the patient if his/her condition worsens