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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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why are we here
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 here1
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.
concussion mild 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
Symptoms Reported by a Student

Source: Centers for Disease Control and Prevention (CDC)

thinking remembering
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
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
Emotional

A student may report:

  • Irritable
  • Sad
  • More emotional than usual
  • Nervous

Source: Centers for Disease Control and Prevention (CDC)

sleep
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
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
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 signs1
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
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

slide17

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)

second impact syndrome
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
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

stepwise guidelines
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
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
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 school1
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
Know Your Concussion ABCs

Source: Centers for Disease Control and Prevention (CDC)

remember
Remember:

No two concussions are the same!!

and

When in doubt, sit it out!!

references
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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