1. HEAD INJURIES

2. PREVENTION Protective Equipment is crucial
Must be in good, working condition
Must be used properly
Must fit the athlete properly
Examples: helmet, face guard, mouthguard, eye ear, and throat protector

3. Scalp Injuries It is the outermost covering of the cranium
Highly vascular and bleeds freely
Primary concern = control bleeding, prevent contamination, and rule out skull fracture!

4. Skull Fracture Different signs may appear
Palpate to feel depressed bone or chunks of bone
Raccoon eyes (discoloration) = fracture at eyebrow level
Battle’s Sign (discoloration behind the ear) = fracture above and behind ear
Blood or cerebrospinal fluid may leak from the ears or nose

5. Cerebral Conditions
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)
Vein damaged: slower onset (24 to 72 hours), slower bleeding and swelling
Both are life-threatening!!!!!!

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

8. Impact causes Acceleration
Shock waves pass through skull to brain
Causes acceleration
Leads to :
tensile forces :
compressive forces :
shear forces :

9. Concussions
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.
The more concussions you sustain, the more severe they become, and the easier it is to get one!

10. Amnesia Post Traumatic Amnesia (PTA)
Definition = the inability to recall events that have occurred since the time of injury.
Retrograde Amnesia (RA)
Definition = the inability to remember events that occurred before the injury

11. ESPN Concussions

12. Second Impact Syndrome
An athlete sustains a 2nd head injury before the symptoms associated with a previous head injury have cleared.
This causes an increase in intracranial pressure.
Leads to respiratory arrest or death.

13. (( )) 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
(( ))

14. Assessment of Concussions
Palpate the neck: look for any deformities or painful areas
Orientation x 4 : who are they, where are they, what happened, and when????
Move down body w/ symptoms
Head
Neck
Muscles
Stomach
Function

15. Pupils PEARL Nystagmus – Eye Tracking Pupils Equal And Reactive to
Light
Nystagmus – Eye Tracking

16. Assessment of Concussions
Pulse
Blood Pressure
Respirations
Reflexes
Dermatomes
Myotomes
Rhomberg Test
T 1-2
T 3
T 4
T 5
T 6
T 7-8
T 9-10
T 11-12

17. Cranial Nerves Olfactory Smell Optic Sight Occulomotor Eye Movement
Trochlear Eye Movement
Trigeminal Facial Motion/ Sensation
Abducens Eye Movement
Facial Facial Expression/ Sensation
Vestibulochochlear Hearing and Balance
Glossopharengeal Tongue and Throat
Vagus Digestion/ Excretion
Accessory Head, Neck, Shoulder muscles
Hypoglossal Speech, Swallowing
Cranial Nerves

18. Assessment of Concussions
Immediate Memory:
- 3 Words
Concentration
Months in reverse order
Delayed Word Recall
Exertion Maneuver
Jumping jacks, Sit ups, Push ups, Squats
Neurological Screening
Loss of Consciousness – Y / N if yes how long?
Pre- & Post- Amnesia
Strength
Coordination
- Finger to Nose
- Straight line test: can they walk the line?

19. GRADE 1 GRADE 2 Remove from activity Transient confusion
CONCUSSION
GRADE
SIGNS & SYMPTOMS
MANAGEMENT
GRADE 1
Transient confusion
NO loss of consciousness
All symptoms gone in < 15 minutes
Remove from activity
Examine immediately
Re-examine at 5-10 minute intervals
If asymptomatic, stress test
May return to play if symptoms resolve in < 15 mins.
GRADE 2
Symptoms last > 15 minutes
Disallow return that day
May refer to ER for further testing (i.e., CT scan)
Re-evaluate the following day
May return to play after 1 week of being asymptomatic at rest & stress

20. CONCUSSION
GRADE
SIGNS & SYMPTOMS
MANAGEMENT
GRADE 3
Any loss of consciousness
Remove from activity
Examine immediately
Refer to ER for further testing (i.e., CT scan)
Generally, out of activity for 1 month once asymptomatic
RETURN TO ACTIVITY IS NOT ALLOWED UNTIL ALL SYMPTOMS HAVE RESOLVED AT REST AND UNDER STRESS.