Head injuries concussions
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Head Injuries / Concussions. Prevalent in collision and contact sports Education and protective equipment are critical in preventing head injuries Head trauma results in more fatalities than any other sports injury. Mild Head Injuries

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Head Injuries / Concussions

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Head injuries concussions

Head Injuries / Concussions

  • Prevalent in collision and contact sports

  • Education and protective equipment are critical in preventing head injuries

  • Head trauma results in more fatalities than any other sports injury


Head injuries concussions

  • Mild Head Injuries

    • Immediate and transient post-injury impairment of brain function

    • Mechanism of injury

      • Direct blow

      • Acceleration/deceleration forces

        • Shaking and/or shearing forces to the brain

        • Sudden snapping of the head

          • Forward

          • Backward

          • Rotating to the side


Head injuries concussions

  • Signs and Symptoms

    • May present as

      • Life-threatening injury

      • Cervical injury (if unconscious)

      • Loss of consciousness (LOC)

        • May last seconds or minutes

      • Post-traumatic amnesia lasting < 24 hours

    • Other symptoms

      • Disorientation

      • Motor coordination or balance deficits

      • Cognitive deficits

    • Variety of scales and return to play criteria

      • Typically involve LOC or amnesia


Head injuries concussions

  • Management

    • Any LOC requires the athlete be removed from competition

    • Assume a cervical spine injury with any LOC

    • Athlete should be referred to a physician for assessment

    • Athlete should not be left alone following a concussion for 24 hours or until a physician determines supervision is no longer necessary

    • Objective measures should be used to determine readiness for return to play

      • SAC Test (Standard Assessment of Concussion)

      • BESS Test (Balance Error Scoring System)

    • Return to normal baseline requires approximately 3-5 days

    • All post-concussive symptoms should be resolved

    • Return to play should be gradual


Head injuries concussions

  • Second impact syndrome

    • Mechanism of injury

      • Recurrent concussions can produce cumulative injury to the brain

      • After 1st concussion the chances of a 2nd concussion are 3-6x’s greater

      • Occurs before symptoms of the initial injury have resolved

      • Second impact

        • May be relatively minimal

        • May not involve contact w/ the cranium

      • Result of rapid swelling and herniation of brain after a second head injury

      • Disrupts the brain’s blood autoregulatory system

        • Leading to swelling

        • Increasing intracranial pressure

      • Very serious condition


Head injuries concussions

Second Impact Syndrome

  • Management

    • Life-threatening injury

    • Must be addressed w/in 5 minutes

    • Life saving procedures at trauma center

    • Activate 911

    • Best management is prevention

    • Physician’s clearance for return to activity

  • Signs and Symptoms

    • Athlete may not have LOC

    • Athlete may looked stunned

    • Condition degrades rapidly w/in 15 secs.

      • Dilated pupils

      • Loss of eye movement

      • LOC leading to coma

      • Respiratory failure

      • May lead to death


Head injuries concussions

  • History

    • Loss of consciousness and for how long?

    • Orientation (x’s 4)

      • Person (who you are / who MD is at hospital)

      • Place (where they are)

      • Time (day, month, year)

      • Event (more reliable test with athletes)

    • History of prior concussions

      • How many

      • Date of last one

      • Loss of consciousness (knocked out)

    • Medications

      • Use of blood thinners (anti inflammatory medications)

      • Alcohol use

    • Amnesia (memory deficit)

      • Retrograde amnesia (memory of events before the injury)

        • Can you remember who we played last week?

      • Antegrade amnesia (memory of events after the injury)

        • Can you remember walking off the field


Head injuries concussions

  • History

    • Headache

      • Quantity (Severity of pain: 0 -10 scale)

      • Quality (sharp, stabbing, throbbing, ache)

      • Constant or intermittent

    • Neck pain

      • Evaluate motor function

        • Can you move your hands and feet?

        • Feelings of weakness

        • Wiggle fingers and toes

      • Sensory assessment

    • Nausea

    • Dizzyness / Vertigo / Balance problems

    • Change in sleep pattern / feeling sluggish

    • Visual disturbances

      • Blurry vision

      • Double vision

      • Red or purple haze to vision

      • Sensativity to light

    • Concentration or memory problems


Head injuries concussions

  • Observation

    • General impression of the athlete

      • Is there a blank or vacant stare?

      • Can the athlete keep their eyes open?

      • Inability to focus attention

      • Is the athlete easily distracted?

      • Normal emotional response?

    • Speech

      • Slurred speech

      • Incoherent speech

    • Verbal response

    • Motor response

    • Gross disturbances to coordination?

    • Cognitive function?


Head injuries concussions

  • Observation

    • Swelling or bleeding from the scalp?

    • Deformity

    • Cerebrospinal fluid leaking from

      • Ear canal

      • Nose

    • Discoloration

      • Behind the ears (Battle’s sign)

      • Under the eyes (Raccoon eyes)

  • Palpation for point tenderness and deformity

    • Neck

    • Skull

  • Special Tests

    • Vital signs

      • BP

      • Increase in systolic

      • Decrease in diastolic


Head injuries concussions

  • Special Tests

    • Eye function

      • Pupils

      • Equal (same size or irregular)

      • And

      • Reactive to (constrict with increased light)

      • Light (Penlight or ambient room light or sunlight)

      • Accommodation

        • Ability of pupils to accommodate to light variance

          • Dilate for far away

          • Constrict for close up

      • Eye position

        • Strabismus

      • Eye tracking - smooth or unstable

        • Nystagmus

        • Vision up and down, side to side (bowtie pattern)

        • Convergence with close up focus

      • Visual acuity (Blurred vision / Eye chart)

      • Peripheral and tunnel vision

      • Close eyes tightly or open them widely


Head injuries concussions

  • Special Tests

    • Ear function (test hearing by rubbing fingers together)

    • Nose (test smell with mild agent, ie soap or coffee)

    • Mouth

      • Smile or frown

      • Bite down hard

      • Hold mouth open against resistance

      • Tongue

        • stick tongue straight out (say ah)

        • Push tongue against cheek on each side

        • Uvula retracts as tongue sticks out

        • Gag reflex

    • Skin

      • Sensation 3 zones


Head injuries concussions

  • Balance Tests

    • Romberg Test

      • Assess static balance

      • Determine individual’s ability to stand and remain motionless

      • Time (30 seconds)

      • Position

        • Feet together

        • Arms out in front at shoulder height

        • Head tipped all the way back

        • Eyes closed

    • Balance Error Scoring System

  • Coordination tests

    • Finger to nose

    • Heel-to-toe walking


Head injuries concussions

  • Cognitive Tests

    • Obtains objective measures to assess patient status and improvement

    • On or off-field assessment

      • Serial 7’s

      • Months in reverse order

      • Counting backwards

      • Tests of recent memory

        • Score of contest

        • Breakfast

        • Prior game

        • 3 word recall


Balance error scoring system bess

Balance Error Scoring System (BESS)

  • Positions

  • 1. On firm surface

    • a. Feet side by side

    • b. Single foot balance

  • c. One foot behind other

  • 2. On unstable surface

    • a. Feet side by side

    • b. One foot balance

    • c. One foot behind other

  • Quantifiable clinical battery of tests

  • Eyes are closed in all positions during test

  • Utilizes different stances on both firm and foam surface

  • Errors are tabulated when the athlete

    • Opens their eyes

    • Takes hands off hips

    • Steps/stumbles or falls


Head injuries concussions

Loss of Consciousness

Bleeding/Swelling

Blood/CSF Ears or Nose

Vital Signs

Headache

Nausea/vomiting

Sleep Problems

Amnesia

Person Place Date Event

Months Backward

7’s countdown

Memory 3 Item Recall

Medication

Red/Purple Haze

Photosensitive

Pupil Size & Equality

Light Reaction

Eye Position

Eye Tracking

Tunnel/Peripheral

Visual Acuity

Smile

Frown

Eyes Open/Closed

Sensation

Smell

Open Mouth

Bite

Tongue Out/Gag

Tongue Strength

Hearing

Muscles of Expression

Weakness or LossSensation

Balance/Rhomberg

Heel to Toe Walk

Shoulder Shrug

Finger to Nose

Coordination

Heel to Knee


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