Injuries to the Head, Neck & Spine

Cerebral Conditions Impact or injuries causes bleeding within the brain called HEMATOMAS 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) 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 Vein damaged: slower onset (24 to 72 hours), slower bleeding and swelling  Both are life-threatening!!!!!!

Concussions Definition = the temporary impairment of brain function caused by impact to the head, or rotational force 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. 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! The more concussions you sustain, the more severe they become, and the easier it is to get one!

Concussions Football Softball Basketball

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

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

Concussions Treatment: Treatment: Careful removal from play Careful removal from play Thorough physical and neurological examination Thorough physical and neurological examination Refer to physician for follow-up examination Refer to physician for follow-up examination

Concussions Concussions Assessment: Assessment: Neuropsychological Testing Neuropsychological Testing If possible, preseason testing on a computerized system (ImPACT). If possible, preseason testing on a computerized system (ImPACT). If a concussion occurs, retest injured athlete following recommended protocols. If a concussion occurs, retest injured athlete following recommended protocols. Thorough evaluation of athlete: Thorough evaluation of athlete: (Sport Concussion Assessment Tool (SCAT 2) is a tool that can be used to evaluate a concussed athlete. (Sport Concussion Assessment Tool (SCAT 2) is a tool that can be used to evaluate a concussed athlete. Physical Examination – evaluation of athletes physical symptoms as listed previously. Physical Examination – evaluation of athletes physical symptoms as listed previously. Assessment of Concussions

Concussions Concussions Assessment Assessment Cognitive testing Cognitive testing Immediate memory testing Immediate memory testing What month is it? What month is it? What time is it?, etc. What time is it?, etc. Concentration Concentration Months of year backward Months of year backward 100-7, continue backward 100-7, continue backward Delayed Recall – have athlete remember words, repeat at later time Delayed Recall – have athlete remember words, repeat at later time Assessment of Concussions

Concussions Concussions Assessment Assessment Balance/Coordination testing Balance/Coordination testing Balance Error Scoring System (BESS) Balance Error Scoring System (BESS) Romberg Test Romberg Test Finger to Nose Finger to Nose Assessment of Concussions

Common Injuries – Head/Neck Return to Play Guidelines: Return to Play Guidelines: Depends on the level of play of the athlete involved. Currently, the NCAA, UHSAA, and a new Utah State law regarding youth sports (HB 204) will dictate a specific plan for concussion management and return to play guidelines. It will include some variation of the following : Depends on the level of play of the athlete involved. Currently, the NCAA, UHSAA, and a new Utah State law regarding youth sports (HB 204) will dictate a specific plan for concussion management and return to play guidelines. It will include some variation of the following : Progression through Return-To-Play stages on a case by case basis with final clearance by an approved, licensed health care professional: Progression through Return-To-Play stages on a case by case basis with final clearance by an approved, licensed health care professional:

Common Injuries – Head/Neck

Second Impact Syndrome Second Impact Syndrome Rapid swelling of the brain from additional head trauma; life threatening Rapid swelling of the brain from additional head trauma; life threatening Second impact could be minor Second impact could be minor Could be caused by blow to chest that accelerates head. Could be caused by blow to chest that accelerates head. Signs and Symptoms Signs and Symptoms No initial loss of consciousness No initial loss of consciousness Rapid worsening leading to: Rapid worsening leading to: LOC progressing to coma LOC progressing to coma Dilated pupils Dilated pupils Loss of eye movement Loss of eye movement Respiratory failure Respiratory failure Treatment : Immediate transport to medical facility Treatment : Immediate transport to medical facility Prevention Prevention DO NOT LET THIS SITUATION OCCUR! Careful decision making regarding return to play following initial head trauma

Common Injuries – Head/Neck Post-Concussion Syndrome Post-Concussion Syndrome Persistent symptoms following concussion - May begin immediately following injury and may last for weeks to months Persistent symptoms following concussion - May begin immediately following injury and may last for weeks to months Persistent headache Persistent headache Impaired memory Impaired memory Lack of concentration Lack of concentration Anxiety Anxiety Irritability Irritability Fatigue Fatigue Depression Depression Continued visual disturbances Continued visual disturbances Treatment – No clear guidelines Treatment – No clear guidelines Treat symptoms to greatest extent possible Treat symptoms to greatest extent possible Return athlete to play when all signs and symptoms have fully resolved Return athlete to play when all signs and symptoms have fully resolved

ESPN Concussions OTL: College Football Concussions OTL: College Football Concussions OTL: College Football Concussions OTL: College Football Concussions

Scalp Injuries Highly vascularized; bleeds freely Highly vascularized; bleeds freely Laceration Laceration Control bleeding Control bleeding Prevent contamination Prevent contamination Assess for skull fracture (fx) Assess for skull fracture (fx) Management: Management: If no fx, cleanse, cover, and refer If no fx, cleanse, cover, and refer Abrasions and contusions Abrasions and contusions Cleanse; ice and pressure Cleanse; ice and pressure 24 hours: no improvement – refer 24 hours: no improvement – refer

Skull Fracture Types Types Linear Linear Comminuted Comminuted Depressed Depressed Basilar Basilar

Skull Fracture (cont.) Potential for varying signs and symptoms Potential for varying signs and symptoms Visible deformity–do not be misled by a “goose egg”; a fracture may be under the site Visible deformity–do not be misled by a “goose egg”; a fracture may be under the site Deep laceration or severe bruise to scalp Deep laceration or severe bruise to scalp Palpable depression or crepitus Palpable depression or crepitus Unequal pupils Unequal pupils Raccoon eyes or Battle’s sign Raccoon eyes or Battle’s sign

Skull Fracture (cont.) Bleeding or CSF from nose and/or ear Bleeding or CSF from nose and/or ear Battle Sign Battle Sign Raccoon Eye’s Raccoon Eye’s “Halo” Sign “Halo” Sign Loss of smell Loss of smell Loss of sight or major vision disturbances Loss of sight or major vision disturbances Unconsciousness  2 minutes after direct trauma to the head Unconsciousness  2 minutes after direct trauma to the head Management: activation of EMS Management: activation of EMS

Facial Conditions Facial soft tissue conditions Facial soft tissue conditions Contusions, abrasions, and lacerations are managed the same as elsewhere on the body Contusions, abrasions, and lacerations are managed the same as elsewhere on the body Complicated injuries—immediate physician referral Complicated injuries—immediate physician referral

Nasal Conditions Epistaxis (nose bleed) Epistaxis (nose bleed) Anterior – bleeding from anterior septum Posterior – bleeding from lateral wall Anterior – bleeding from anterior septum Posterior – bleeding from lateral wall Management: ice, mild pressure, slight forward head tilt; nasal plug;  5 minutes – physician referral Management: ice, mild pressure, slight forward head tilt; nasal plug;  5 minutes – physician referral Deviated septum Deviated septum S&S S&S Consistent difference in airflow between the 2 sides of the nose when one nostril is blocked Consistent difference in airflow between the 2 sides of the nose when one nostril is blocked Confirm using otoscope Confirm using otoscope Management: physician referral Management: physician referral

Nasal Conditions (cont.) Fractures Fractures Most common: lateral displacement Most common: lateral displacement Range of severity varies Range of severity varies S&S S&S Asymmetry – especially with lateral force Asymmetry – especially with lateral force Epistaxis Epistaxis Crepitus Crepitus Management: control bleeding; refer Management: control bleeding; refer

Ear Conditions Cauliflower ear (auricular hematoma) Cauliflower ear (auricular hematoma) Repeated trauma Repeated trauma Untreated – forms a fibrosis Untreated – forms a fibrosis Management: ice; possible aspiration by physician Management: ice; possible aspiration by physician Key is prevention Key is prevention

Eye Conditions Preorbital ecchymosis (black eye) Preorbital ecchymosis (black eye) Assessment Assessment Management: ice, referral to ophthalmologist Management: ice, referral to ophthalmologist Foreign bodies Foreign bodies S&S: intense pain, tearing S&S: intense pain, tearing Management Management Not embedded: removal, inspection Not embedded: removal, inspection Embedded: do not touch, activate EMS Embedded: do not touch, activate EMS

Eye Conditions (cont.) Orbital “blowout” fracture Orbital “blowout” fracture Impact from a blunt object, usually larger than the eye orbit Impact from a blunt object, usually larger than the eye orbit S&S: S&S: Diplopia Diplopia Numbness below eye Numbness below eye Lack of eye movement Lack of eye movement Recessed downward displacement of globe Recessed downward displacement of globe Management: ice; immediate referral to physician Management: ice; immediate referral to physician

Cervical Spine Fracture Fracture S&S S&S Pain Pain Numbness Numbness Tingling Tingling Management Management Spinal immobilization Spinal immobilization Refer to a physician Refer to a physician

Brachial Plexus 31 pairs of spinal nerves 31 pairs of spinal nerves Brachial C5-T1 Brachial C5-T1 “Stinger” “Stinger” Numbness Numbness Loss of function Loss of function Management Management Remove from play Remove from play Allow RTP once symptoms resolve Allow RTP once symptoms resolve

Guess the Injury! Ouch…that hurts!

DIRECTIONS: For each of the following slides, try to identify the type of injury that has occurred. For each of the following slides, try to identify the type of injury that has occurred. Write your answer on your paper. Write your answer on your paper.

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Answers 1. Concussion 2. Scalp Laceration 3. Battle Sign 4. Deviated Septum 5. Foreign object 6. Preorbital Ecchymosis (Black Eye) 7. Epistaxis (nose bleed) 8. Cauliflower Ear 9. Orbital Fracture 10. Brachial Plexues