written by Gileswench and Foxmom

It's a sad fact of life: Giles gets hit on the head a lot. The episodes where he stays alert and conscious for the entire hour are few and far between. It became such a common occurance that meta-references show up in several scripts, such as The Replacement: "Well, I'm not dead or unconscious, so I say bravo for me."

Giles having a concussion is a common theme in fanfic, as well, but how many of us really know much about the condition? The following is a helpful set of common questions about concussion as asked by Gileswench and their answers as provided by Foxmom, a Giles lover and RL(Real Life) RN(Registered Nurse).

Please keep in mind that this article is meant for the purposes of fic writing only. If you or someone you know has been knocked on the head, don't attempt to diagnose or treat concussion by yourself. That's what doctors, nurses, and ERs are for.

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Q: What are concussions?

A: Concussions occur due to trauma. They are the result of your brain literally bouncing around inside your skull. A person may or may not lose consciousness. Giles tended to get knocked out every time on the show, but it is not necessary to be knocked out to suffer a concussion. Another name is Brain Injury.

Q: What are the symptoms? How do people suffering from them generally behave?

A: Acute symptoms can include: loss of consciousness, apnea (the stopping of respiration for a short time), nausea and vomiting, slow heart beat, low blood pressure, short term memory loss especially of the events just prior to the accident, disorientation and of course headache.

Post concussion syndrome can develop immediately upon regaining consciousness or may not develop until a day or so later. These symptoms can include: Headache, irritability, nervousness, visual problems, dizziness, confusion, staggering or problems with balance.

Q: How long does it usually take to recover from a mild concussion? A severe one?

A: These symptoms can resolve within a few weeks but can last up to a year! Now, you see why Giles could not have functioned physically after repeated head injuries like he suffered on Buffy... multiple traumas. But recovery is usually expected to be complete.

There are more severe forms of head injury, Like skull fractures, resulting hematomas and contusions of the brain area...the list goes on and on.

Q: What sort of tests would a doctor perform to identify a concussion?

A: Most hospitals will automatically do a CAT scan or MRI to rule out more serious injuries, but diagnosis is by history (what happened) and assessment. The MD will check level of consciousness: is the victim alert and awake, lethargic, or out cold? If he is out cold, the MD will usually assess using the Glasgow Coma scale. Reflexes will be assessed, which can be sluggish but are intact in a concussion. The pupils are assessed, which should be equal and reactive. Unequal reactions of the pupils indicate a more severe head injury than concussion. There are not really lab tests and the like, it is mostly monitoring.

Q: What treatment would a hospital give a victim suffering a concussion?

A: When you go to the ER with a head injury, they will certainly insert a line for IV access, but not give fluid, just a catheter in a vein just in case. This is called an INT for intermittent infusion. Oxygen will be placed using a nasal cannula (the tube that goes around the ears and has two little prongs in the nose). Routinely a heart monitor, blood pressure monitor and an O2 sat monitor will be put on Giles, since, after all, we know he's the one who got knocked unconscious in your fic. The O2 sat monitor is a clothespin like device that is clipped on a finger. It checks Oxygen Saturation in the blood, normal is above 90% and healthy people will usually have an O2 sat of 97-100%. A general physical is done.

Most patients are kept for observation anywhere from a few hours, for someone who did not lose consciousness, to a couple of days. Anyone who loses consciousness is usually kept for 23 hour observation. This way nurses can observe for complications and worsening head injury. They will look for the same types of things that Buffy (or whichever Scooby is watching Giles) is watching for. Here are some discharge instructions the ER would give after Giles checked himself out AMA:

For 24 hours someone should wake him every two hours. Duck that flying teacup after the third or fourth time you wake him up...and for gosh sakes don't have sex with him. He should be kept quiet and calm (Giles never has quiet calm orgasms) and he should not work, drive, drink alcohol or take any pain meds except Tylenol. Drink clear liquids only for 24 hours or as tolerated - tea is fine of course. Things to report to the doctor: vomiting more than two times, fever, stiffness of the neck, confusion, seizures or convulsions, stumbling, inability to wake up, weakness in arms or legs especially one sided, drainage from the ear, worsening headache not responding at all to Tylenol, unequal pupils and difficulty speaking or swallowing.

Q: Are there long-term effects to watch out for?

A: If it is just a concussion, recovery should be complete.

Q: How about for someone who has had several?

A: There is a cumulative effect. As often as he was knocked out on the show, it is a wonder Giles could remember anything. He would probably take longer to fully recover with each successive injury.

BUT, this is Giles we are talking about...he has a hard head!

Q: Where can I find out more information?

A: A great site for useful info is CDC

For radiology questions, visit: Radiology Info

Another useful source is the Merck Manual. Also, anyone can go the their local emergency room and ask for the patient info they give you when you are discharged from the hospital.

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