STEP 2: Concussion Live Course - October 21-22, 2025, in Salt Lake City, UT-Case Discussion: Assessing Concussion in the Emergency Department

Pdf Summary

The case describes a 39-year-old male who, after a traumatic experience as a lifelong Seattle Mariners fan, sustained an operative clavicle fracture following a fall from a Lime scooter after the Mariners' Game 7 ALCS loss. He presented to the emergency department (ED) with obvious shoulder deformity, pain, confusion (GCS 14), and was treated with IV fentanyl and morphine. Witnesses reported one minute of loss of consciousness, vomiting, hostility, disorientation, and tearfulness attributed to emotional distress over the team's loss.<br /><br />Orthopedics performed a successful open reduction internal fixation (ORIF) of the clavicle fracture, and the patient was discharged with outpatient follow-up and oral opioids. At his four-day follow-up, the patient reported unusual symptoms including severe headache, nausea, blurred vision, sleepiness, inability to concentrate, irritability, and a "hungover" feeling. He was diagnosed with a mild traumatic brain injury (concussion) that was initially missed due to prioritization of his obvious fracture.<br /><br />Education emphasized that concussion symptoms are typically self-limited over 2-4 weeks but can be prolonged. Recommendations included avoiding alcohol, limiting opioid use, no scooter riding, and physical therapy for vestibular assessment before return to activity. Further mental health support such as counseling, short-term SSRIs, and cognitive behavioral therapy were advised to address emotional symptoms, given his multigenerational trauma and ongoing psychological impact.<br /><br />The discussion highlighted the challenges of managing emergent injuries (clavicle fracture) while potentially missing subtler diagnoses (concussion) in the chaotic ED environment. The case underscores the importance of thorough follow-up to identify and manage all patient issues. The patient’s prognosis remains cautiously optimistic with multidisciplinary support.

Asset Subtitle

Charlie D. Kenyon, DO, MS

Keywords

clavicle fracture

traumatic brain injury

concussion

Seattle Mariners fan

Lime scooter accident

emergency department

open reduction internal fixation

opioid management

vestibular assessment

mental health support