Concussion Assessment Vidal Mora, L.A.T., A.T.C.

Defining Concussion a traumatically induced transient disturbance of brain function and involves a complex pathophysiologic process. Concussion is a subset of mild traumatic brain injury that is generally self- limited and at the less severe end of the brain injury spectrum.

Suspecting Concussion Mechanism: most common is head contact or whiplash Direct Blows (Struck in head with object) (Moving head strikes fixed object) Coup injury that occurs on the same side of the brain as the impact Contrecoup injury that occurs on opposite side of the brain from where impact occurred

Keep in mind of… History of Concussions History of Migraines Cerebral Contusions Hematomas- intracranial, epidural, subdural Lacerations Spine Injuries Skull Fractures

Equipment for Assessment Small Kit/backpack Cervical Collar Pen Light Pen/Notepad Watch/timer Blood Pressure Cuff/Stethoscope Reflex Hammer Ophthalmoscope Otoscope Concussion Checklist Cheat Sheet. Standardized Assessment of Concussion Form

SCAT 5 Form Sport Concussion Assessment Tool For medical professionals Used for assessment after first aid/emergency care priorities are completed Modify if need be Self-explanatory/easy/free http://bjsm.bmj.com/content/bjsports/early/2017/04/26/bjsports-2017- 097506SCAT5.full.pdf Child Form – ages 5-12 http://bjsm.bmj.com/content/bjsports/early/2017/04/26/bjsports-2017- 097492childscat5.full.pdf

Immediate Assessment Red Flags Observable signs Memory Assessment Questions Examination Cervical Spine Assessment

SCAT 5 Neck pain or tenderness Double Vision Weakness or tingling/burning in arms or legs Severe or increasing headache Seizure or convulsion Loss of consciousness Deteriorating conscious state Vomiting Increasingly restless, agitated or combative

SCAT 5

Brief Memory Assessment/SCAT5 Modified Questions What happened? What’s your name? Where are you? What time is it?

Amnesia Retrograde Amnesia Anterograde Amnesia No memory for things that occurred before the injury Example: Patient does not know what they ate for breakfast. Anterograde Amnesia No memory for things that occurred after the injury Example: Patient does not know who helped them up off the ground

SCAT5

Initial Assessment Management Check ABCs/ Heart Function Mental Status Deteriorating, abnormal neurological findings, and/or worsening symptoms Immediate transfer to ED More serious brain injury can be excluded Physical Exam – Rule Out Spine Injury Spine injury CAN be ruled out More detailed history of injury and examination with symptoms, cognitive, balance assessments, and neurological examination should be initiated When Clinical Assessment can takes place If spine injury cannot be eliminated Immobilize neck and 911

Clinical Assessment /Side Notes Patient Background Symptom Evaluation Cognitive Screening Neurological Screening Delayed Recall Decision/Plan Preferable to do in a quiet, more calm area Without distractions Resting State Also if patient is accompanied make sure the company does not try to answer questions for patient Time of complete assessment can’t be done in less than 10 mins

Pre-Clinical Assessment Vital Signs Height Weight Temperature Pulse/HR BP Respiration Pain

Background Document subjective material Patient background and information Past history Neurological diagnoses Medicine

Symptoms - Checklist Two Primary: Disturbances in level of consciousness, and posttraumatic amnesia Blurred vision Confusion Dizziness Drowsiness Excess Sleep Easily Distracted Fatigue/Low Energy Feel “in a fog” Feel “slowed down” Headache Inappropriate Emotions Irritability Loss of Consciousness Loss of Orientation Memory Problems Nausea Nervousness Personality change Poor balance/coordination Poor Concentration Pressure in Head Ringing in Ears Sadness Seeing Stars Sensitivity to Light Sensitivity to Noise Sleep Disturbance Vacant stare/Glassy eyed Vomiting

SCAT5

SCAT 5

SCAT5

SCAT 5

Neurological Screening/SCAT5 Cranial Nerves Olfactory Optic Oculomotor Trochlear Trigeminal Abducens Facial Vestibulocochlear Glossopharyngeal Vagus Accessory Hypoglossal

Special Tests SCAT5 Finger nose coordination test Tandem gait Appendicular coordination Rapid alternating movements Precision finger tap Heel-shin overshoot Tandem gait Romberg test (mBESS) testing (Pictured)

SCAT 5

SCAT5

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