1. THE HEAD
Chapter 18

2. DON‘T MESS WITH YOUR HEAD!
THE HEAD
An athlete with a possible head injury must be cared for quickly to reduce chances of possible permanent injury or even death.
DON‘T MESS WITH YOUR HEAD!

3. I. HEAD ANATOMY A. The Brain 1. Is made up of billion of cells
2. Only weighs about 3 lbs, but requires 20% of all oxygen and 15-20% of blood supply

4. I. HEAD ANATOMY
3. Brain cells grow and develop until about age 18
~ after that they can be destroyed but not reproduced

5. HEAD ANATOMY
4. Depriving the brain of O2 will lead to unconsciousness
~ after 4-6 minutes of unconsciousness, brain death begins to occur

6. A. THE BRAIN
5. The Brain is divided into different lobes, each named for the bony structure of the skull that covers it
a. Frontal Lobe
b.Parietal Lobe
c. Temporal Lobe
d. Occipital Lobe

7. A. THE BRAIN 6. Each lobe is responsible for different body functions
7. Attaches to the spinal cord at the brain stem via a crossover so that the right hemisphere (side of brain) controls the left side of the body and vice versa.

8. A. THE BRAIN 8. The brain is protected by:
a. the 28 bones that make up the skull
b. Cerebrospinal fluid (bathes the brain and spinal cord in chemicals for proper functioning) maintains the surrounding pressure and protects from impacts
With severe head injuries, sometimes cerebrospinal fluid drains from eyes, ears,or nose. It is clear and should be allowed to drain since otherwise the pressure inside the head rises too high and will cause more brain damage.

9. B. THE SKULL 1. The skull has 28 bones
2. The only movable bone in the skull is the mandible (lower jaw)
3. The skull is crucial in protecting the brain

10. 1. Skin covering the skull 2. Protects by cushioning skull
C. THE SCALP
1. Skin covering the skull
2. Protects by cushioning skull
3. Contains large numbers of blood vessels, muscles, and hair
4. Even tiny lacerations in the scalp bleed profusely due to the large number of blood vessels
without the scalp an impact of only 40 lbs could fracture the skull...due to the layer of scalp the skull can withstand forces of up to 425lbs
If blood vessels break without injury to the skin a bump will develop, such as often seen in cartoons

11. II. INJURY PREVENTION Head injuries can be prevented by: 1. Helmets
2. Mouth Guards
3. Sports Rules
4. Proper techniques

12. II. INJURY PREVENTION B. Mouth guards
Prevent concussions and dental injuries
absorb the shock from the mandible hitting the maxilla
unprotected the brain stem can twist leading to unconsciousness
that#‘s why Anja gets very edgy with FB players who don‘t wear their mouthpiece in practices!

13. II. INJURY PREVENTION
2. In order to prevent injuries the mouthguard must be in good condition
3. Chewed up or cut off mouthpieces will not prevent the knock-out effect

14. III. HEAD INJURIES
The most common mechanism of head injuries is impact
Either to skull or body

15. III. HEAD INJURIES
When the head is moving and receives a blow the brain sloshes to the opposite side, where it is abruptly stopped by the skull...this is where the brain injury occurs
contrecoup

16. III. HEAD INJURIES A. Skull Fractures 1. Mechanism of Injury:
direct impact

17. III. HEAD INJURIES 2. Signs and Symptoms:
a. Battle sign = discoloration behind the ear
b. Possible loss of or altered state of consciousness
c. Possible bleeding or drainage of cerebrospinal fluid from mouth, nose, ears

18. III. HEAD INJURIES 3. Treatment: a. Call 911
b. Stabilize athlete in position found until EMS arrives

19. III. HEAD INJURIES
c. An impact great enought to fracture the skull will most likely result in brain injury and has the potential to have fractured the cervical spine as well

20. III. HEAD INJURIES B. Concussions
1. Defined as a temorary impairment of brain function
2. All concussions should be evaluated and treated carefully, since the athlete‘s life may be in jeopardy

21. III. HEAD INJURIES
3. Concusions can be graded in many different ways (from a mild bump to coma and death)

22. WebMD concussion grades
Grade 1 concussion, symptoms last for less than 15 minutes. There is no loss of consciousness.
Grade 2 concussion, there is no loss of consciousness but symptoms last longer than 15 minutes.
Grade 3 concussion, the person loses consciousness, sometimes just for a few seconds.

23. III. HEAD INJURIES Mechanism of Injury: 1. direct impact or
2. rotation force

24. III. HEAD INJURIES Signs and Symptoms may include:
1. headache, dizziness, confusion, nausea, vomiting, blurred vision (near and/or far), ringing in the ears, loss of balance

25. III. HEAD INJURIES
2. loss of memory (=amnesia) regarding events that happed either before and/or after the impact, loss of consciousness

26. III. HEAD INJURIES Treatment: 1. Remove athlete from competition
2. If there was a loss of consciousness stabilize the cervical spine (expect possible neck injury) and

27. 3. Call 911
Any athlete who has suffered a concussion must be cleared by a physician before (s)he can return to activity
Even a slight impact to the brain can cause bleeding and complications that can lead to a coma and/or death!

28. III. HEAD INJURIES C. Intracranial Hematoma
1. Is defined as severe bleeding within the brain

29. III. HEAD INJURIES
2. Increases the pressure on the brain to a level where rapid cell death can occur
3. Can be a secondary condition associated with concussions

30. III. HEAD INJURIES
4. Occasionally are misevaluated as mild concussions and the athlete is being sent home

31. III. HEAD INJURIES
5. In this case chances of him falling into a coma or dying over night are high
6. Chances of survival after being in a coma are only 40%

32. III. HEAD INJURIES Signs and Symptoms: Headache Nausea and vomiting
Loss of Consciousness
Paralysis of one body side
Battle Sign
Increasing BP / decreasing pulse rate

33. III. HEAD INJURIES Treatment:
Onset of signs and symptoms may be gradual, therefore an athlete with any possible head injury needs to be monitored for at least 24 hours

34. III. HEAD INJURIES
(S)he should be awakened every couple hours during the night to detect any worsening of the condition
WHY?

35. III. HEAD INJURIES
2. CALL 911! If any of above mentioned signs and symptoms are present or the condition of the athlete deteriorates.

36. III. HEAD INJURIES
3. Depending of the severity of the hematoma the athlete may fully recover, suffer permanent brain impairment, or die

37. III. HEAD INJURIES D. POSTCONCUSSION SYNDROME
1. is the persistence of symptoms after a concussion, such as, Headache, Dizziness, Ringing in the ears, Confusion, Difficulty concentrating

38. III. HEAD INJURIES 2. Athlete needs follow-up evaluation by physician
3. Symptoms should clear within 1-2 weeks

39. III. HEAD INJURIES E. SECOND IMPACT SYNDROME occurs when an athlete:
1. returns to competition before all signs of his previous concussion have cleared

40. III. HEAD INJURIES
2. When he receives repetitive (even minor) blows to the head in a short time
3. Disturbs the brain‘s blood supply and presents signs of a minor concussion, which quickly turn into a semi-comatose state

41. III. HEAD INJURIES
4. All athletes need clearance from a MD before being allowed back on the playing field after suffering possible head injury!!!

42. Head Injury Evaluation Process
Step 1
Short-term memory
What did you have for lunch?
How did you get here?
What just happened?

43. Head Injury Evaluation Process
Step 2
Long-term memory
What is your mother’s name?
What is your phone number?
Where were you born?
What day of the week is it?

44. Head Injury Evaluation Process
Steps 3-6
Eye Movements
Instruct athlete not to move head, follow with eyes.
Stabilize athletes chin with other hand
Use only index finger.
Move finger in front of athletes face slowly

45. Head Injury Evaluation Process
Step 3
Eye tracking - 4 quadrants (IV – Trochlear)
Move finger in cross patterns
Continually change direction

46. Head Injury Evaluation Process
Step 4
Eye Tracking - Peripheral Vision (VI – Abducens)
Move finger to side of athletes face
Both right and left sides
Don’t move past ability to see
Hold position at end range (3 secs)

47. Head Injury Evaluation Process
Step 5
Eye Tracking - cross eyed (III – Occulomotor)
Bring finger to nose and ask athlete to follow finger
Hold position for 3 seconds

48. Head Injury Evaluation Process
Step 6
Near & Far Sight (II – Optic)
Near - Ask athlete to state number of fingers in front of face
Far - Ask athlete to read something at a distance
Time on clock, scoreboard, name on back of jersey, etc.

49. Head Injury Evaluation Process
Step 7
Pupil Reaction to light (III – Oculomotor)
Stabilize athletes head by holding chin
Begin with light on side of head
Move light in close proximity to face until light contacts pupil
Quickly remove and watch pupil reaction

50. Head Injury Evaluation Process
Step 8
Tactile sensation (VII – Facial)
Touch each cheek one at a time and in same direction, movement, type
Ask athlete if they feel it and if it is the same on both sides.

51. Head Injury Evaluation Process
Step 9
Hearing (VIII – Vestibulocochlear)
Rub fingers together next to each ear (one at a time)
Ask athlete if they hear it and if it is the same on both sides.

52. Head Injury Evaluation Process
Step 10
Tongue movement (XII – Hypoglossal)
Ask athlete to stick out tongue and move from side to side

53. Head Injury Evaluation Process
Step 11
Cough reflex (X – Vagus)
Ask athlete to cough

54. Head Injury Evaluation Process
Step 12
Balance (VIII – Vestibulocochlear)
Ask athlete to stand with feet together, hands at sides.
Ensure you are prepared to catch them
Ask athlete to close their eyes.

55. Head Injury Evaluation Process
Evaluating results: