Sports Concussion: Sideline and Initial Management Jim Fiechtl, MD Assistant Professor: Depts. Of EM and Orthopedics Vanderbilt Bone and Joint Clinic Vanderbilt Bone & Joint

Disclosures Unfortunately, I have no financial disclosures to make, but I am always willing to listen. Vanderbilt Bone & Joint

Objectives How to recognize? What we are doing on the sideline? Who goes to the ER Vanderbilt Bone & Joint

Who is concussed? Vanderbilt Bone & Joint

Who is concussed? Vanderbilt Bone & Joint

Who is concussed? Vanderbilt Bone & Joint

Who does the evaluation? Anyone trained – Means someone has been trained – Coach – Certified Athletic Trainer – Physician – Team Parent Vanderbilt Bone & Joint

What are we looking for? Lying on the ground/slow to get up – Are they unconscious? Unsteady or wobbly Grabbing their head Dazed, blank look Confused, running wrong plays Vanderbilt Bone & Joint Pocket Concussion Recognition Tool™

Lying Motionless If unconscious, assume a cervical spine injury – C-spine control – Activate Emergency Action Plan Take your time – ensure safety Needs to go to Emergency Department Vanderbilt Bone & Joint 20&h=337

Able to Move Take your time – ensure safety Move them to a ‘quiet’ area on the sideline Give the player a few minutes to catch breath Observe Vanderbilt Bone & Joint

Sideline Assessment Maddocks’ Questions – What city and stadium? – Opponent? – Month and day? – Remember being injured, score of the game, the play, etc Memory and Cognition – Months, 3 objects, numbers backwards Vanderbilt Bone & Joint

Sideline Assessment Brief Neuro Exam – Cranial nerves – Strength – Balance – Cerebellar Vanderbilt Bone & Joint

When can they go back in? They’re done for the day. Vanderbilt Bone & Joint

Who needs a trip to the ER? Worsening headache or symptoms Drowsy, hard to awaken Repeated vomiting Unusual behavior Seizures Weakness or numbness in arms or legs Slurred speech, unsteady walking Vanderbilt Bone & Joint imdb.com/images/M/MV5BMjA0NjI0ODgzNF5BMl5BanBn _.jpg Putukian. BJSM 2013;47:285-8.