Head Trauma in Sports Injuries McKay Fall 2017

Learning Objectives Define a concussion and asses the severity Understand the key signs and symptoms of a concussion, and how to provide appropriate care for a concussed athlete. Develop a plan of treatment based on that assessment Form a plan for return to competition for the athlete

“If ever I need a brain transplant, I want one from a sports writer, ‘cause I know it’s never been used.” Joe Paterno, Penn State Football Coach

What is a Concussion A concussion by definition, means “to shake violently.” A blow to the head or to another part of the body, with force transmitted to your head, that causes the brain to shake inside the skull and result in “EVEN A BRIEF AND MILD” alteration in brain function is considered a concussion. Concussion can be caused by a blow to the head, or to another part of the body with the force transmitted to the head. Most concussions are caused by a rapid acceleration or deceleration of the brain within the skull.

Mental Status Exam Checklist to Identify a Concussion Affect/appearance Orientation (time, day/date, place, situation) Memory (immediate recall, recent, remote) Intellect (calculations) Judgment

PREVIOUS CONCUSSION CLASSIFICATION (Prior to 2011-12) Grade 1: Confusion without amnesia, no loss of consciousness. Grade 2: Confusion with amnesia, no loss of consciousness (not lasting longer than TWO- THREE minutes) Grade 3: Loss of consciousness (lasting longer than 3 minutes This is the OLDER version of how concussions where defined and identified. DO NOT COPY THIS SLIDE

TODAY’s Concussion Classification A CONCUSSION is a CONCUSSION! Standing Management and protocol procedures will be followed each individual case.

Signs/Symptoms of a Concussion Amnesia (memory recall) Confusion or appearing dazed Headache or head pressure Loss of consciousness Balance difficulty Dizziness Double or blurry vision Fatigue or sleep issues Sensitivity to light or sound Nausea, vomiting, or loss of appetite Irritability or changes in personality Feeling sluggish, foggy, groggy Concentration or focusing problems Slow reaction times

Signs and Symptoms that Indicate an Athlete Needs Emergency Evaluation I 1. Impairment of consciousness (or changes in mental status or behavior, increasing or continued) Need 2. Nausea and vomiting My 3. Motor activity, decreased, unequal, or pathologic posturing. Very 4. Vital Signs (ventilation, pattern, blood pressure, or decreasing pulse rate)

Head 6. Headaches, Increasing Protection 7. Pupillary inequality Special 5. Seizures Head 6. Headaches, Increasing Protection 7. Pupillary inequality Important: Remember, the forces that cause a head injury may also produce cervical spine injuries.

Sports Associated with a High Risk of Concussions Auto Racing Boxing Equestrian Sports Football Ice Hockey Lacrosse Martial Arts Motorcycle Racing Rugby Skating Rollerblading Skiing Soccer (goalie) Pole Vaulting

Two Sports with the Highest Rate Boxing/UFC Football

Zachary Lydstett Law https://www.youtube.com/watch?v=wb6Bm5skuBA

Summary of Concussion and Preview for Treatment https://www.youtube.com/watch?v=cmQ- crhciJw

What Do I Do if I Suspect a Concussion? Any athlete suspected of a concussion should be removed from the game or practice immediately. Continue to monitor the player after your initial evaluation. Make sure the athlete is supervised for at least one or two hours after you suspect a concussion. Do not allow the athlete to return to play until you have received written clearance from a licensed health care provider trained in the evaluation and management of brain injuries. If you suspect a concussion remove the athlete from play immediately. Continue to monitor the athlete and make sure the parents are notified. Make sure the athlete is supervised for at least one or two hours after you suspect a concussion. Do Not allow the athlete to return to play until you have received written clearance from a licensed health car provider trained in the evaluation and management of brain injuries.

Health Care Providers What health care providers are licensed and trained in the evaluation and management of brain injuries: Medical Doctors (MD) Doctor of Osteopathy (DO) Advanced Registered Nurse Practitioner (ARNP) Physicians Assistant (PA) Licensed Certified Athletic Trainers (ATC) This is a current list of which health care providers are licensed in the State of Washington with training in the evaluation and management of brain injuries.

WHAT SHOULD A COACH DO WHEN A CONCUSSION IS SUSPECTED? ACTION PLAN WHAT SHOULD A COACH DO WHEN A CONCUSSION IS SUSPECTED?

ACTION PLAN Remove the athlete from play. Look for the signs and symptoms of a concussion if your athlete has experienced a bump or blow to the head. Athletes who experience signs or symptoms of concussion should not be allowed to return to play. When in doubt, keep the athlete out of play.

ACTION PLAN Ensure that the athlete is evaluated right away by an appropriate health care professional. Do not try to judge the severity of the injury yourself. Health care professionals have a number of methods that they can use to assess the severity of concussions. As a coach, recording the following information can help health care professionals in assessing the athlete after the injury: Cause of the injury and force of the hit or blow to the head Any loss of consciousness (passed out/knocked out) and if so, for how long Any memory loss immediately following the injury Any seizures immediately following the injury Number of previous concussions (if any)

ACTION PLAN Inform the athlete’s parents or guardians about the possible concussion and direct them to the Parent Information Sheet in the Co- Curricular Athletic Handbook (also available on the district athletic web site) . Make sure they know that the athlete should be seen by a health care professional experienced in evaluating for concussion.

ACTION PLAN Allow the athlete to return to play only with permission from a LICENSED health care professional with experience in evaluating for concussion. A repeat concussion that occurs before the brain recovers from the first can slow recovery or increase the likelihood of having long-term problems. Prevent common long-term problems and the rare second impact syndrome by delaying the athlete’s return to the activity until the player receives appropriate medical evaluation and approval for return to play.

Licensed Health Care Providers What licensed health care providers are trained in the evaluation and treatment of concussions/brain injuries and authorized to allow the athlete to return to play? Medical Doctors (MD) Doctor of Osteopathy (DO) Advanced Registered Nurse Practitioner (ARNP) Physicians Assistant (PA) Licensed Certified Athletic Trainers (ATC) Research is currently being done to determine which other licensed health care providers may have sufficient training to qualify to authorize return to play.

Return To Play Must be symptom free without medication for 24 hours. Day 1: Low level physical activity (light Jogging, Stationary Bike, Walking) Day 2: Moderate Levels of Physical Activity (Weightlifting) Day 3: Heavy non-contact physical activity (Sports Specific Drills) Day 4: Non-contact sports specific practice. Day 5: Unrestricted Full contact practice Satisfactory Neuro-cognitive Scores Compared To Baseline No earlier than 48-72 hours post injury. May only move 1 step per day. Any symptoms require starting the RTP process over.

summary If you think your athlete has sustained a concussion… take him/her out of play, and seek the advice of a health care professional experienced in evaluating for concussion.

Other BRAIN Related Injuries There are many other brain related issues that can occur with concussions.

What is Second Impact Syndrome? Second Impact syndrome is the rapid development of diffuse brain swelling in the setting of a recent head injury followed by a second impact to the head. Only impacts people under the age of 23

Preston Plavertes LINK https://www.youtube.com/watch?v=F4foY1EtmKo

Leading Cause of Death From Athletic Head Injury * Intracranial hemorrhage- which is defined as the leaking of blood within the brain, due to a result of a concussion/head injury

Immediate Management of an Athlete who has Collapsed Protect the cervical spine ABCs for CPR Hyperventilation to reduce CO2 Transport to medical facility Evaluation to include CT or MRI scans

Signs of a Temporal Lobe Herniation Increasing blood pressure and decreasing pulse Contralateral himparesis and ipsilateral dilated pupil– occurs with unilateral temporal lobe herniation Bilateral pyramidal tract signs- paresis/paralysis with bilateral dilated pupils Impairment of respiration and consciousness

Signs of Basilar Skull Fracture Bruises or bleeding behind the ear, in ear canal, and/or around the eye Blood or CSF exiting from the ear or nose Hearing loss Lack of smell Facial paralysis