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Medical Author:

John P. Cunha, DO, FACOEP

John P. Cunha, DO, FACOEP

John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Bleeding under the scalp, but outside the skull, creates a "goose egg" or large bruise (hematoma) at the site of the head injury. A hematoma is common and will go away on its own with time. The use of ice immediately after the trauma may help decrease its size.

• Do not apply ice directly to the skin - use a washcloth as a barrier and wrap the ice in it. You may also use a bag of frozen vegetables wrapped in cloth, as this conforms nicely to the shape of the head.
• Apply ice for 20-30 minutes at a time and repeat about every two to four hours. There is little benefit after 48 hours.
• Rest is important to allow the brain to heal.

In 2010, the American Academy of Neurology called for any athlete suspected of having a concussion to be removed from play until the athlete is evaluated by a physician. If a concussion is suspected due to a sports injury, the Centers for Disease Control recommends implementing a 4-step plan:

1. Remove the athlete from play.
2. Ensure that the athlete is evaluated by a health care professional experienced in evaluating for concussion. Do not try to judge the severity of the injury yourself.
3. Inform the athlete's parents or guardians about the possible concussion and give them the fact sheet on concussion.
4. Keep the athlete out of play the day of the injury and until a health care professional, experienced in evaluating for concussion, says they are symptom-free and it's OK to return to play.

A repeat concussion that occurs before the brain recovers from the first - usually within a short period of time (hours, days, or weeks) - can slow recovery or increase the likelihood of having long-term problems. In rare cases, repeat concussions can result in edema (brain swelling), permanent brain damage, and even death.

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