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Concussion. Jennifer L. Doherty, MS, LAT, ATC Management of Medical Emergencies. Concussion. Head/Brain injury Temporary impairment of brain function MOI: Direct or Indirect blow to the head. Concussion. Serious head injuries almost always represent a life-threatening situation

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concussion

Concussion

Jennifer L. Doherty, MS, LAT, ATC

Management of Medical Emergencies

concussion2
Concussion
  • Head/Brain injury
  • Temporary impairment of brain function
  • MOI: Direct or Indirect blow to the head
concussion3
Concussion
  • Serious head injuries almost always represent a life-threatening situation
  • Must get athlete to the hospital immediately
    • Within 30 minutes
signs and symptoms
Signs and Symptoms
  • Altered level of consciousness (LOC)
  • Pain or pressure in the head
  • Tingling or loss of sensation in the extremities
  • Partial or complete loss of movement in any body part
signs and symptoms cont
Signs and Symptoms cont…
  • Unusual lumps or depressions on the head
  • Blood or other fluids in the ears or nose
  • Profuse bleeding from the head
  • Seizures
  • Impaired breathing
  • Impaired vision
signs and symptoms cont6
Signs and Symptoms cont…
  • Nausea or vomiting
  • Persistent headache
  • Loss of balance
  • Ecchymosis
    • Especially around the eyes or behind the ears
signs and symptoms cont7
Signs and Symptoms cont…
  • The S/S of a head/brain injury may not be apparent until hours after the trauma occurs
  • Immediate referral to a physician is important for the proper treatment of a serious head/brain injury
primary assessment
Primary Assessment
  • Must be able to recognize and interpret the S/S of a head injury
  • If an athlete is unconscious, ALWAYS assume injury to the neck as well
primary assessment cont
Without moving the athlete, assess the airway

Athlete is breathing

Airway is obstructed

Observe for S/S of head and neck injury

Face color

Skin condition

Pulse

Breathing

Pupils

Edema

Ecchymosis

Deformity

Primary Assessment cont…
secondary assessment
Secondary Assessment
  • Assess mental orientation and memory
  • What is your name?
  • How old are you?
  • Where are you?
  • What game are you playing?
  • What is the score?
  • What month is it?
  • Who is president?
  • After 5-10 minutes, ask the same questions again
secondary assessment cont
Secondary Assessment cont…
  • Test for “Eye signs”
  • Dilated and/or irregular pupils
  • Blurred vision
  • Inability for eyes to accommodate rapidly to light variance
  • Inability for eyes to track smoothly
    • nystagmus
secondary assessment cont12
Secondary Assessment cont…
  • Balance Testing
  • Stand with eyes closed
  • Stand on one foot
  • Stand on one foot with eyes closed
  • Finger-to-Nose test
  • Babinski Test
  • Reflex tested by running a pointed object along the bottom of the foot
  • Normal response is toe flexion
concussion classification
Concussion Classification
  • There are many ways to classify concussions
  • Different Grading Scales exist
    • Cantu (1986)
    • Colorado Medical Society (1991)
    • Torg (1991)
    • American Academy of Neurology (1997)
    • Guskiewicz/University of North Carolina (1998)
general concussion classification
General Concussion Classification

Grade I Concussion

  • Normal consciousness
  • No memory loss
  • May elicit mild disorientation
  • S/S resolve within 5-15 minutes
  • Most common concussion sustained in sports
general concussion classification15
General Concussion Classification

Grade II Concussion

  • Normal consciousness
  • Confusion
  • Post-traumatic amnesia
    • Inability to recall events that have occurred since the time of injury
  • Unsteadiness/Dizziness
  • Tinnitus
  • Headache
general concussion classification16
General Concussion Classification

Grade II Concussion cont…

  • Post-concussion Syndrome
    • Difficulty concentrating
    • Recurring headaches
    • Irritability
  • S/S may last several weeks
  • Athlete may not return to play until all S/S are resolved
general concussion classification17
General Concussion Classification

Grade III Concussion

  • Normal consciousness
  • Confusion
  • Post-traumatic amnesia
  • Retrograde amnesia
    • Inability to recall events that occurred before the injury
general concussion classification18
General Concussion Classification

Grade III Concussion cont…

  • Unsteadiness/Dizziness
  • Tinnitus
  • Headache
  • Confusion
general concussion classification19
General Concussion Classification

Grade III Concussion cont…

  • This athlete must be referred to a physician for a thorough examination
  • An intracranial lesion may be present
    • Results in intracranial bleeding
    • Causes a gradual increase in intracranial pressure
general concussion classification20
General Concussion Classification

Grade IV Concussion

  • Loss of consciousness
  • Referred to as “Paralytic Coma”
    • Return to consciousness usually within a few seconds or minutes
  • Post-traumatic amnesia
  • Retrograde amnesia
  • Post-concussion Syndrome
general concussion classification21
General Concussion Classification

Grade IV Concussion cont…

  • While returning to consciousness, the athlete will display states of:
    • Stupor
    • Confusion
    • Delirium
  • Medical Emergency
    • Suspect neck injury also
    • Spine board the athlete
    • Transport the athlete to the hospital immediately
general concussion classification22
General Concussion Classification

Grade V Concussion

  • Paralytic Coma
  • Secondary cardio-respiratory collapse
  • The Glasgow Coma Scale is used to determine the state of the athlete
slide23

Glasgow Coma Scale

Lowest score = 3, Highest score = 15

general concussion classification24
General Concussion Classification

Grade VI Concussion

  • Death
secondary conditions associated with concussions
Secondary Conditions Associated with Concussions
  • Intracranial Hemorrhage
  • Skull Fracture
  • Epidural Hemorrhage
  • Subdural Hemorrhage
  • Intracerebral Hemorrhage
  • Cerebral Hyperemia
  • Cerebral Edema
  • Seizures
  • Migraine Headaches
intracranial hemorrhage
Intracranial Hemorrhage
  • Intracranial bleeding
  • Venous bleeding
    • Slow, insidious onset
  • Arterial bleeding
    • S/S apparent within a few hours
intracranial hemorrhage27
Early S/S

Severe head pains

Dizziness

Nausea

Unequal pupil sizes

Sleepiness

Severe S/S

Deteriorating consciousness

Neck rigidity

Slow pulse

Slow respiration

Convulsions

Intracranial Hemorrhage
epidural hemorrhage
Epidural Hemorrhage
  • A blow to the head causes a tear in one of the arteries of in the dural membrane that covers the brain
  • Hematoma forms extremely fast
    • Within 10 – 20 minutes after injury
epidural hemorrhage29
Epidural Hemorrhage
  • Requires surgery to relieve the pressure created by the hemotoma
  • Death or permanent disability may result
subdural hemmorhage
Subdural Hemmorhage
  • A blow to the head causes a tear in one of the veins located between the dura mater and the brain
  • Hematoma forms slowly
    • S/S may not be appear until hours after injury
subdural hemmorhage31
Subdural Hemmorhage
  • Commonly occurs following a contrecoup injury
  • May or may not require surgery
intracerebral hemorrhage
Intracerebral Hemorrhage
  • A blow to the head may cause bleeding within the brain itself
  • Usually results due to a compressive force applied to the brain
  • Rapid deterioration in neurological function
  • Requires immediate hospitalization
cerebral hyperemia
Cerebral Hyperemia
  • Vasodilation of cerebral blood vessels following a head/brain injury
  • Causes an increase in intracranial blood pressure
  • Develops within minutes after the injury
  • S/S: headache, vomiting, sleepiness
  • S/S usually resolve within 12 hours after the injury
cerebral edema
Cerebral Edema
  • Localized swelling of the brain at the injury site
  • Develops within 12 hours after the injury
  • S/S: headache, seizures (occasionally)
  • Cerebral edema may remain for as long as 2 weeks following the injury
criteria to return to play
Criteria to Return to Play
  • Normal neurological function
  • Normal vasomotor functions
  • Normal balance
  • Free of headaches
  • Free of lightheadedness
  • Free of dizziness
  • Free of seizures
criteria to return to play mild concussion
Criteria to Return to Play: Mild Concussion
  • First Concussion
    • Return to play if asymptomatic
  • Second Concussion
    • Must be asymptomatic for 1 week
  • Third Concussion
    • Terminate season
    • May play next year if asymptomatic
criteria to return to play moderate concussion
Criteria to Return to Play: Moderate Concussion
  • First Concussion
    • Must be asymptomatic for 1 week
  • Second Concussion
    • Must be asymptomatic for 1 month
  • Third Concussion
    • Terminate season
    • May play next year if asymptomatic
criteria to return to play severe concussion
Criteria to Return to Play: Severe Concussion
  • First Concussion
    • Must be asymptomatic for 1 month
  • Third Concussion
    • Terminate season
    • May play next year if asymptomatic
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