HEAD INJURIES

PREVENTION Protective Equipment is crucial Must be in good, working condition Must be used properly Must fit the athlete properly Examples: helmet, face guard, mouthguard, eye ear, and throat protector

Scalp Injuries It is the outermost covering of the cranium Highly vascular and bleeds freely Primary concern = control bleeding, prevent contamination, and rule out skull fracture!

Skull Fracture Different signs may appear Palpate to feel depressed bone or chunks of bone Raccoon eyes (discoloration) = fracture at eyebrow level Battle’s Sign (discoloration behind the ear) = fracture above and behind ear Blood or cerebrospinal fluid may leak from the ears or nose

Cerebral Conditions Impact or injuries causes bleeding within the brain called HEMATOMAS Artery damaged: quick decline in mental status and functioning of the brain (10 – 20 minutes) Vein damaged: slower onset (24 to 72 hours), slower bleeding and swelling Both are life-threatening!!!!!!

Mechanisms Direct impact causes two conditions 1. deformation 2. acceleration Direct blow can cause fracture at the site of impact Direct blow can cause fracture at site away from area of impact Concussion Animation

Impact causes Acceleration Shock waves pass through skull to brain Causes acceleration Leads to : tensile forces : compressive forces : shear forces :

Concussions Definition = the temporary impairment of brain function caused by impact to the head, or rotational force Usually caused by a direct hit to the head, plus the injury to the opposite side of the brain where the brain bounces off of the skull. The more concussions you sustain, the more severe they become, and the easier it is to get one!

Amnesia Post Traumatic Amnesia (PTA) Definition = the inability to recall events that have occurred since the time of injury. Retrograde Amnesia (RA) Definition = the inability to remember events that occurred before the injury

ESPN Concussions http://www.youtube.com/watch?v=jH867uCahEE

Second Impact Syndrome An athlete sustains a 2nd head injury before the symptoms associated with a previous head injury have cleared. This causes an increase in intracranial pressure. Leads to respiratory arrest or death.

(( )) Signs and Symptoms Dizziness Headache Excessive Drowsiness Unable to focus or concentrate »Irritable and Confused » Convulsions * Nystagmus *Visual problems - Bleeding from nose or ears -Tinnitus (ringing in ears) ~Paralysis ~Weakness in limbs or face ∞Memory problems ∞Balance problems Nausea Vomiting (( ))

Assessment of Concussions Palpate the neck: look for any deformities or painful areas Orientation x 4 : who are they, where are they, what happened, and when???? Move down body w/ symptoms Head Neck Muscles Stomach Function

Pupils PEARL Nystagmus – Eye Tracking Pupils Equal And Reactive to Light Nystagmus – Eye Tracking

Assessment of Concussions Pulse Blood Pressure Respirations Reflexes Dermatomes Myotomes Rhomberg Test T 1-2 T 3 T 4 T 5 T 6 T 7-8 T 9-10 T 11-12

Cranial Nerves Olfactory Smell Optic Sight Occulomotor Eye Movement Trochlear Eye Movement Trigeminal Facial Motion/ Sensation Abducens Eye Movement Facial Facial Expression/ Sensation Vestibulochochlear Hearing and Balance Glossopharengeal Tongue and Throat Vagus Digestion/ Excretion Accessory Head, Neck, Shoulder muscles Hypoglossal Speech, Swallowing Cranial Nerves

Assessment of Concussions Immediate Memory: - 3 Words Concentration Months in reverse order Delayed Word Recall Exertion Maneuver Jumping jacks, Sit ups, Push ups, Squats Neurological Screening Loss of Consciousness – Y / N if yes how long? Pre- & Post- Amnesia Strength Coordination - Finger to Nose - Straight line test: can they walk the line?

GRADE 1 GRADE 2 Remove from activity Transient confusion CONCUSSION GRADE SIGNS & SYMPTOMS MANAGEMENT GRADE 1 Transient confusion NO loss of consciousness All symptoms gone in < 15 minutes Remove from activity Examine immediately Re-examine at 5-10 minute intervals If asymptomatic, stress test May return to play if symptoms resolve in < 15 mins. GRADE 2 Symptoms last > 15 minutes Disallow return that day May refer to ER for further testing (i.e., CT scan) Re-evaluate the following day May return to play after 1 week of being asymptomatic at rest & stress

CONCUSSION GRADE SIGNS & SYMPTOMS MANAGEMENT GRADE 3 Any loss of consciousness Remove from activity Examine immediately Refer to ER for further testing (i.e., CT scan) Generally, out of activity for 1 month once asymptomatic RETURN TO ACTIVITY IS NOT ALLOWED UNTIL ALL SYMPTOMS HAVE RESOLVED AT REST AND UNDER STRESS.