1. Anatomy and Injuries to the Head

2. Anatomy of head 22-28 bones in skull Frontal, ethmoid, sphenoid, lacrimal, parietal (2), temporal (2), zygoma, occipital, nasal (2), maxilla, mandible Bones are joined in immovable joints called sutures Mandible is only movable bone Skull Anatomy Tutorial

3. Skull

4. skull

5. Skull inferior view

6. Brain Part of CNS weight= 3 lbs. Uses 20% of O2 supply & 15% of blood supply Cells grow/develop until age 18—then they will be destroyed but not reproduced

7. brain O2 deprivation results in unconsciousness and death Pupils will dilate w/in 60 seconds Brain death occurs in about 4-6 minutes

8. Sections of Brain Cerebrum 4 lobes Cerebellum Pons and Medulla oblongata Make up brain stem

9. Sections of Brain

10. Cerebrum Coordinates all voluntary muscle activity Interprets sensory impulses Controls higher mental functions Memory, reasoning, intelligence, learning, judgment, emotions

11. 4 lobes of cerebrum Temporal Hearing, speech Parietal sensation Occipital vision Frontal Voluntary muscle movement, emotion, eye movement

12. Cerebrum

13. Cerebellum Controls movements of skeletal muscles Plays role in coordination of voluntary muscle movement

14. Brain stem Pons Controls sleep, posture, respiration, swallowing, bladder Medulla oblongata Regulates heart rate, breathing, blood pressure, coughing, sneezing, vomiting

15. Brain Stem

16. Meninges 3 membranes that protect the brain and spinal cord Dura Mater Arachnoid Pia Mater

17. Dura Mater Outer most layer Separated from bony wall of skull by layer of fat Contain vital arteries and veins Forms the epidural space

18. Arachnoid space Lines the dura mater

19. Pia Mater Membrane that lies directly on the brain Helps contain the cerebrospinal fluid

20. Subarachnoid Space Space between the arachnoid and pia mater

21. Meninges

25. Cerebrospinal fluid Clear amber in color Contained in the subarachnoid space Surrounds and suspends the brain Has chemicals that assist in proper functioning of brain Maintains regular pressure around brain Protects brain from impact

26. Cerebrospinal fluid w/ severe injury fluid may drain from ears and nose Let it drain Stopping it will increase pressure in skull Could cause more damage

27. Scalp Covers skull Contains large # of blood vessels, muscles and hair Skin protects against infection, keeps dirt and sweat away from eyes Decreases force of impact due to additional padding Increases inelasticity created by tension of connective tissue

28. Thought for the day To preserve brain function is to maintain quality of life, which depends on how a brain injury is handled.

29. Prevention of head injuries Use helmets & mouth guards Follow the rules of the sport Learn proper skills and techniques and use them Use common sense

30. Injuries Common mxn is impact and/or rotation Contra coup occurs when head is moving and receives a blow—brain moves to opposite side of blow and is stopped by skull. That is where the injury occurs Rotation after impact: causes brain stem to stop functioning normally. Nerve receptors are overloaded which can cause unconsciousness. Allows for brain to sort out impulses

31. Skull Fracture Various kinds Depressed Pushes portion of skull in towards brain Linear Goes across skull causing tear of vessels on inside of skull Compound Results in a portion of skull sticking through scalp Penetrating Involves object that has gone through scalp, skull, brain

32. Skull Fracture Mxn: Direct blow to head, blunt trauma to skull S/S: severe headache, nausea, defect in skull, bleeding in ears/nose, raccoon eyes, Battle sign, cerebrospinal fluid in ears/nose Care: call 911, immobilize head/neck, monitor, perform life saving skills if necessary

33. Skull Fracture Complication: Intracranial bleeding Bone fragments embedded in brain infection

34. Battle Sign Discoloration behind ear due to skull fracture

35. Skull Fracture

37. Concussion Temporary impairment of brain function Alters consciousness Disturbs vision Alters equilibrium

38. Concussion Mxn: Direct blow to head Contra coup injury Acceleration/deceleration/rotation forces that shake the brain w/in the skull

39. Concussion

40. S/S: Headache Dizziness Blurry vision Double vision Tinnitus Nausea Vomiting Photophobia

41. Concussion S/S: Unequal or non responsive pupils Pupils don’t track or “flutter” Confusion Disorientation Loss of balance (equilibrium) LOC (loss of consciousness) or altered Amnesia (post traumatic or retrograde) Difficulty concentrating

42. Concussion Care: Remove from activity until all symptoms clear With LOC, send to ER Seek medical attention if symptoms remain Physician clearance to return to activity

43. Concussion

45. Post concussion syndrome Persistent symptoms after initial concussion Symptoms include headache, dizziness, nausea, tinnitus, confusion, inability to concentrate, fatigue Can last up to a couple weeks or longer Cannot participate until all symptoms are clear

46. Second Impact Syndrome Damage from concussions and brain injury is cumulative Occurs as result in rapid swelling of brain following a 2 nd head injury sustained prior to symptoms of 1 st concussion being resolved 2 nd blow can be minor Most likely to occur in athletes under 20 years old

47. Second impact syndrome S/S: “stunned” Walk off field on own power Lose consciousness soon after—lead to coma Dilated pupils Loss of eye movement Respiratory failure MORTALITY rate----50%

48. Second impact syndrome Care: Call 911 Life threatening emergency that should be dealt with w/in 5 minutes in an ER PREVENTION is the best care

49. Intracranial Hematoma Severe bleeding w/in the brain Intracerebral bleeding Hematoma caused increase in pressure on brain Rapid death can occur Mxn: direct blow to head or head striking an immoveable object Temporal or parietal regions are more vulnerable

50. Intracranial hematoma S/S: will vary LOC Headache Dizziness Nausea Possible paralysis Increased blood pressure Decreased pulse rate

51. Intracranial hematoma Care: Call 911 Monitor athlete Perform any life saving skills necessary until EMS arrives

52. Intracranial hematoma

53. Epidural Hematoma Tear in meningeal arteries that are embedded in bony grooves of skull Formation of hematoma very quickly due to arterial blood pressure

54. Epidural hematoma Mxn: Blow to head Results of skull frature

55. Epidural hematoma S/S: LOC After regaining consciousness, may appear completely lucid w/ no symptoms of head injury Symptoms of concussion can appear and gradually worsen Later---decreased level of consciousness, neck rigidity, decreased respiration & pulse rate, convulsions

56. Epidural Hematoma LIFE-THREATENING Care: Call 911 Monitor athlete Live saving skills as necessary

57. Epidural Hematoma

58. Subdural Hematoma Occurs more frequently Involves venous bleeding S/S will appear more slowly—after hours or even days

59. Subdural hematoma Mxn: Acceleration/deceleration forces that tear blood vessels that bridge the dura mater and brain

60. Subdural hematoma S/S: LOC Dilation of one pupil (unequal) usually on same side as injury Headache Nausea Sleepiness Other concussion symptoms

61. Subdural hematoma Care: Call 911 Monitor athlete Life saving skills as necessary

62. Subdural hematoma

63. Comparison of the 3 hematomas

64. Scalp injuries Lacerations Abrasions Contusions hematomas

65. Scalp Injuries Mxn: Blunt or penetrating trauma S/S: Complaints of being hit, bleeding, open wound, deformity (bump) Care: Control bleeding, clean wound, refer for sutures if more that ½” long and 1/8” deep Watch for infection

67. Scalp wounds