EMERGENCY ACTION PLAN On-person equipment On-site equipment Communication Mock up!

COVERINGS OF BRAIN

Epidural Space Subdural Space Subarachnoid Space

Epidural Space - Arteries Subdural Space - Veins Cerebrospinal Fluid SPACES AND CONTENTS

MAJOR STRUCTURES WITHIN SPACES. Epidural space – Arteries Subdural Space – Veins Subarachnoid Space – Cerebrospinal Fluid (CSF)

Middle Meningeal A.

SUBDURAL SPACE

DURA Arachnoid

General Comments Relating to Concussions Caused by direct force to the head or by ‘impulsive’ force transmitted to the head.

General Comments Relating to Concussions Rapid onset of short-lived impairment of neural function. Acute clinical symptoms are functional, not structural in nature.

General Comments Relating to Concussions May or may not involve loss of consciousness. Is typically associated with grossly normal structural imaging study.

DIRECT

INDIRECT

Rotation (Angular) Movement

TRANSLATIONAL FORCE

Acceleration- Deceleration Injury Translation

AB

A B A. Head Hits Object. B. Brain Rebounds

Interference of Neural Function

Unconsciousness ?

1. Reticular Activating System 2. Cerebral Cortex 3. Brain Stem

FOCAL – can be seen by the trained eye. DIFFUSE – can not be seen by the trained eye.

EPIDURAL HEMATOMA

SUBDURAL HEMATOMA

SKULL FRACTURE

Thickness of skull. Magnitude and direction of impact Size of impact area

(signs and symptoms) o Visible deformity o Deep laceration o Depression/ crepitus o Discolouration o CSF from ears or nose

 Battle’s Sign  Raccoon Eyes  Halo Sign

Bruising behind the ear on the Mastoid Process.

INTRACEREBRAL BLEED Focal injury involving small bleeds in the cortex, brain stem or cerebellum. Usually caused by a bruise as a result of the head stopping movement and the brain continues moving.

very rare in sports. direct blow to side of head. Middle Meningeal A. is severed. 1

 May have initial L.O.C. from blow.  Regain and ‘normal’.  min. decline.  Headache, vomiting, drowsiness. 2

 Decrease consciousness.  Dilate pupil on side of bleed.  Opposite side weakness.  Emergency……. Fatal 3

Caused by acceleration of the head rather than impact. Three times more frequent than epidural. Bleed under dura. 1

(Signs & Sym.) Low pressure venous bleeding clots slowly. S&S may become evident for hours, days, weeks. Sometimes accompanied by cerebral swelling. 2

(S&S of Increasing Pressure) Severe headache – Nausea or vomiting – Confusion or Impairment of Consciousness - Rising B.P. – Falling Pulse – Changes in Emotion – C.N. problems (eye tracking). 3

CEREBRAL CONCUSSION Criteria for Severity Consciousness Mental Confusion Memory Loss Tinnitus Unsteadiness

Posttraumatic Amnesia Retrograde Amnesia Anterograde Amnesia R. Cantu.. Journal of Athletic Training. Sept/01

RETROGRADE AMNESIA “ partial or total loss of the ability to recall events that have occurred during the period immediately preceding brain injury.”

ANTEROGRADE AMNESIA “ a deficit in forming new memory after the accident, which may lead to decreased attention and inaccurate perception.”

Postconcussion Signs and Symptoms Depression, Dizziness, Drowsiness, Extreme Sleep, Fatigue, Feel ‘in fog’, Feel ‘slowed down’, Headache, Irritability, Memory problems, Nausea, Nervousness, Numbness/tingling, Poor balance, Poor concentration, Ringing in the ears, Sadness, Sensitive to light, Sensitive to noise, Trouble falling asleep, Vomiting.

CONCUSSIONS Grade I Grade II Grade III

GRADE I No loss of consciousness Post traumatic amnesia or postconcussion signs or symptoms lasting less than 30 minutes. Cantu. J.A.T Vol 36(3):

GRADE II L.O.C. less than 1 minute. Posttraumatic amnesia or postconcussion signs or symptoms lasting longer than 30 minutes but less than 24 hours.

GRADE III Unconscious over 1 min or posttraumatic amnesia lasting longer than 24 hours. Postconcussion signs and symptoms lasting longer than 7 days.

RETURN TO PLAY FOLLOWING CONCUSSION (in one season) If 1 st Gr. I; return if asymptomatic for one week. If 2 nd Gr. I; out for 2 weeks if asymptomatic for one week. If 3 rd Gr. I; zee ya next year!

Return to Play….. Con’t If 1 st Gr.2; return after asymptomatic for one week. If 2 nd Gr.2; 1 month minimum and must by asympt. 1 wk; consider terminating season. If 3 rd Gr.2; terminate season; may return to play next season if asymptomatic.

Return to Play … con’t If 1 st Gr.3; one month and may return if asymptomatic for one week. If 2 nd Gr.3; terminate the season and may play next year if asymptomatic.

Postconcussion Syndrome

Headache Impaired memory Decrease Concentration Irritable, depressed Fatigue Visual disturbance

Second Impact Syndrome

Rare. After initial trauma. Sudden swelling of the brain because of increased blood flow to brain. Usually fatal.

Vaso-Vagal Syncope

Stimulation of Vagus N. at the brain stem (usually by sudden rotation of the head). Dilation of peritoneal blood vessels (pooling of blood).

Decreased oxygen to brain because of decreased cardiac output. Faint. Quick recovery.

DIFFERENCE?

PROTECTIVE EQUIPMENT DEFLECTION DISSIPATION ABSORPTION

DISSIPATION Dispersion – spread the impact over a larger area. Deformation – The energy used to deform material.

Helmets can not prevent rotational or translation motion in the brain. Heavy helmets and helmets with facial protection increase the potential for neck injury.

Mouth guards can reduce the rate of dental and jaw injuries but the reduction in cerebral injuries is largely theoretical and has never been proven scientifically.

The brain can not be conditioned to withstand repetitive trauma. Damage is irreversible and cumulative.

Not all athletes wear helmets and, in many sports, rule changes are slow to happen.