Mild traumatic brain injuries concussions
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Mild Traumatic Brain Injuries (Concussions). Katherine Lynn, RN, BSN. Why are we here?. Why are we here?. 3000 deaths a year are a result of an unintentional traumatic brain injury (TBI). Concussions occur in 10% of high school and college athletes.

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Mild Traumatic Brain Injuries (Concussions)

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Mild Traumatic Brain Injuries(Concussions)

Katherine Lynn, RN, BSN


Why are we here?

Source: The Brain Injury Association of America based on data from the Centers for Disease Control and Prevention, American Cancer Society, and National Multiple Sclerosis Society


Why are we here?

  • 3000 deaths a year are a result of an unintentional traumatic brain injury (TBI).

  • Concussions occur in 10% of high school and college athletes.

  • Children’s brains are more vulnerable to injury and take longer to recover because they are still developing.

  • The brain is more vulnerable to injury after suffering from a concussion.

  • Females are more vulnerable than males and take longer to recover.


Traumatic Brain Injuries


Traumatic Brain Injury


Concussion (Mild Traumatic Brain Injury)

  • Definition:

    • A Complex pathophysiologic process affecting the brain induced by traumatic biomechanical forces altering brain metabolism.

  • Normal brain imaging- no damage to brain anatomy.

    A concussion is a type of brain injury that changes the way the brain normally works.


Symptoms Reported by a Student

Source: Centers for Disease Control and Prevention (CDC)


Thinking/Remembering

A student may report:

  • Difficulty thinking clearly

  • Difficulty concentrating or remembering

  • Feeling more slowed down

  • Feeling sluggish, hazy, foggy, or groggy

Source: Centers for Disease Control and Prevention (CDC)


Physical

A student may report:

  • Headache or “pressure” in head

  • Nausea of vomiting

  • Balance problems or dizziness

  • Fatigue or feeling tired

  • Blurry or double vision

  • Sensitivity to light or noise

  • Numbness or tingling

  • Does not “feel right”

Source: Centers for Disease Control and Prevention (CDC)


Emotional

A student may report:

  • Irritable

  • Sad

  • More emotional than usual

  • Nervous

Source: Centers for Disease Control and Prevention (CDC)


Sleep

A student may report:

  • Drowsy

  • Sleeps less than usual

  • Sleeps more than usual

  • Has trouble falling asleep

    (Only ask about sleep symptoms if the injury occurred on a prior day)

Source: Centers for Disease Control and Prevention (CDC)


Observations

School staff may notice the student:

  • Appears dazed or stunned

  • Is confused about events

  • Answers questions slowly

  • Repeats questions

  • Can’t recall events prior to or after the hit, bump, or fall

  • Loses consciousness (even briefly)

  • Shows behavior or personality changes

  • Forgets class schedule or assignments

Source: Centers for Disease Control and Prevention (CDC)


Danger Signs

  • A student should be taken to the nurse and seen in an ER right away if she/he has:

    • One pupil larger than the other

    • Drowsiness or cannot be awakened

    • A headache that gets worse or doesn’t go away

    • Weakness, numbness, or decreased coordination

    • Repeated vomiting or nausea

Source: Centers for Disease Control and Prevention (CDC)


Danger Signs

  • A student should be taken to the nurse and seen in an ER right away if she/he has:

    • Slurred speech

    • Convulsions or nausea

    • Difficulty recognizing people or places

    • Increasing confusion, restlessness, or agitation

    • Unusual behavior

    • Loss or consciousness (even briefly!!)

Source: Centers for Disease Control and Prevention (CDC)


When to send a student to the health room:

If you notice or suspect that a student has:

Any kind of forceful blow to the head or to the body that results in rapid movement of the head

and/or

Any sign or symptom of a concussion


So what is the big deal?


  • Repeated mild TBIs occurring over an extended period of time (i.e., months, years) can result in cumulative neurological and cognitive deficits.

  • Repeated mild TBIs occurring within a short period of time (i.e., hours, days, or weeks) can be catastrophic or fatal.

    .

Source: Centers for Disease Control and Prevention (CDC)


Tracy’s Story


Second Impact Syndrome

  • Rapid cerebral swelling caused by another injury to the brain while it is still healing from the initial brain injury/concussion

  • Over 80% fatal (the brain swells, bleeds, and the player dies on the field)

  • Usually occurs to children 18 and under.


Prevention

  • Personal Protective Equipment (PPE)

  • Properly fitting equipment

  • Playing by the rules

  • Coach, parent, and family education

  • Baseline testing

  • Heads Up Campaign- http://www.cdc.gov/concussion/headsup/

Source: Amy Valasek, MD FAAP


A Child has a Concussion

Now What?


Stepwise Guidelines

  • Step 1: Complete rest, no activity

  • Step 2: Light exercise such as free play, walking, or stationary cycling for 10-15 minutes

  • Step 3: Sport-specific activity for 20-30 minutes (ex. Skating for hockey, running for soccer)

  • Step 4: “On field” practice with no contact

  • Step 5: “On field” practice with body contact, after medical clearance

  • Step 6: Game Day

    Each step should take a minimum of 24 hours. If any post-concussive symptoms do occur along the stepwise progression, the athlete is required to drop back to the previous asymptomatic stage

Source: McCrory et al., 20091


Students Returning to School May Experience:

  • Difficulty organizing tasks

  • Problems completing activities involving a lot of concentration

  • Problems reading or looking at a computer screen

  • Problems remembering or learning new information

  • Impulsive behavior

  • Irritability

Source: Centers for Disease Control and Prevention (CDC )


Returning to School

  • Students returning to school following a concussion may need to:

    • Take rest breaks as needed

    • Spend fewer hours at school

    • Be given more time to take tests or complete assignments

    • Receive help with schoolwork

    • Reduce time spent on the computer, reading, and/or writing

Source: Centers for Disease Control and Prevention (CDC)


Returning to School

  • Parents, teachers, and support staff meet to develop a plan to support the child as they heal and return to school.

  • The school and family will work together to follow the child’s physician’s orders.

  • As symptoms decrease, extra support can be decreased.

  • Most concussions resolve in 7-10 days. Serious concussions can take up to 2 years to fully recover from.


Know Your Concussion ABCs

Source: Centers for Disease Control and Prevention (CDC)


Remember:

No two concussions are the same!!

and

When in doubt, sit it out!!


Questions?


References

  • McCrory P, Meeuwisse W, Johnston K, Dvorak J, Aubry M, Molloy M, Cantu R. Concensus Statement on Concussion in Sport: the 3rd Internation Conference on Concussion in Sport held in Zurich. Br J Sports Med. 2009;43:i76-i84.

  • Grant, Jo (Speaker). (2012, March 26). Childhood Neurology. PESI HealthCare.

  • Valasek, Amy (Speaker). (2010, March 17). Sport Related Concussion in Pediatric Athletes. Towson Orthopedic Associates.

  • Center for Disease Control and Prevention. Injury prevention and Control: Traumatic Brain Injury. March 29, 2012. http://www.cdc.gov/concussion/index.html.


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