1. Head, Face, Eyes, Ears, Nose and Throat
Oak Ridge High School
Conroe, Texas

2. Neurological Exam Consists of Five Major Areas:
cerebral testing – cognitive functioning
Cranial nerve testing
Cerebellar testing - coordination
Sensory testing
Reflex testing

3. Eye Function Pupils equal and reactive to light (PEARL)
Dilated or irregular pupils. Check with penlight. Some individuals normally have pupils that differ in size.
Inability of the pupils to accommodate rapidly to light variance. Cover with card or hand and expose to light. Slow response may indicate cerebral injury.

4. Eye Function
Eyes track smoothly. Looking for smooth movement and any sign of pain. A constant involuntary back and forth, up and down, or rotary movement of the eyeball is called nystagmus and indicates possible cerebral involvement.
Vision blurred. Have them read a game program or the scoreboard.

5. Balance Test
Also known as Rhomberg test, can be used to assess static balance. Original test is to stand on one leg with eyes closed.

6. Coordination Tests
These test include the finger to nose test, heel to toe walking, and the standing heel to knee test. Inability to perform any of these test may be indicative of injury to the cerebellum.

7. Cognitive Tests
The purpose is to establish the effects of head trauma on various cognitive functions and to obtain an objective measure for assessment of the patient’s status and improvement.
Serial of 7s, in which one counts backward by 7s
Name of the months in reverse order
Careful about questions you ask, make sure you know the answer

8. Skull Fracture
Occur most often form blunt trauma such as a baseball, shot put to the head or a fall.
Signs include severe headache and nausea. Palpation may reveal defect such as indentation. May be bleeding in the middle ear, blood in the ear canal, bleeding through the nose, ecchymosis around the eyes or behind the ears. Cerebrospinal fluid may appear in the ear canal or the nose.

9. Skull Fracture
Management includes immediate hospitalization. The fracture is not the main problem, rather complications that stem form intracranial bleeding and bone fragments embedded in the brain and infection.

10. Concussions
Has been defined as clinical syndrome characterized by immediate and transient posttraumatic impairment of neural functions – such as alterations of consciousness, disturbance of vision, loss of equilibrium, and so on – due to brain stem involvement.

11.
A concussion is a disturbance in brain function that occurs following either a blow to the head or as a result of the violent shaking of the head.

12. Concussion
In the United States, the annual incidence of sports-related concussion is estimated at 300,000. Estimates regarding the likelihood of an athlete in a contact sport experiencing a concussion may be as high as 19% per season.

13. Signs reported by athlete
Concussions
Signs observed
Signs reported by athlete
Appears to be dazed or stunned
Is confused about assignment
Forgets plays
Is unsure of game, score, or opponent
Moves clumsily
Answers questions slowly
Loses consciousness (even temporarily)
Shows behavior or personality change
Forgets events prior to hit (retrograde amnesia)
Forgets events after hit (anterograde amnesia)
Headache
Nausea
Balance problems or dizziness
Double or fuzzy vision
Sensitivity to light or noise
Feeling sluggish
Feeling "foggy"
Change in sleep pattern
Concentration or memory problems

14. Concussion Assessment
Upon ruling out more severe injury, acute evaluation continues with assessment of the concussion. First, the clinician should establish the presence of any loss or other alteration of consciousness (LOC). LOC is relatively rare and occurs in less than 10% of concussions.

15. Concussion Assessment
The identification of LOC can be very tricky, as the athlete may lose consciousness very briefly and this event may not be directly observed by others. By definition, LOC represents a state of brief coma in which the eyes are typically closed and the athlete is unresponsive to external stimuli. LOC is most obvious when an athlete makes no attempt to brace his or her fall following a blow to the head. Any athlete with documented LOC should be managed conservatively, and return to play is contraindicated.

16. Concussion Assessment
Although helpful in identifying more serious concerns (e.g. skull fracture, hematoma, contusion), traditional neurological and radiologic procedures, such as CT, MRI, and EEG, are not useful in identifying the effects of concussion. Such tests are typically unremarkable or normal, even in athletes sustaining a severe concussion. The reason for this issue is that concussion is a metabolic rather than structural injury. Thus, structural neuroimaging techniques are insensitive to the effects of concussion.

17. Concussion Management
At the forefront of proper concussion management is the implementation of baseline and/or post-injury neurocognitive testing. Such evaluation can help to objectively evaluate the concussed athlete's post-injury condition and track recovery for safe return to play, thus preventing the cumulative effects of concussion. In fact, neurocognitive testing has recently been called the "cornerstone" of proper concussion management by an international panel of sports medicine experts.

18. Concussion Management
Current management guidelines (i.e. Grade 1, 2, 3 of concussion) are not evidenced-based and little to no scientific data support the arbitrary systems that are in place to manage concussion. As a result, there are currently 19 different management criteria available for concussion management, which are often misused and misinterpreted.

19. Previous Concussion Grading Chart

20. Postconcussion Syndrome
Is a poorly understood condition that occurs following concussion. It may occur in cases of mild head injury that do not involve loss of consciousness or in cases of severe concussions.

21. Post Concussion Syndrome
Chronic headaches
Fatigue
Sleep difficulties
Personality changes (e.g. increased irritability, emotionality)
Sensitivity to light or noise
Dizziness when standing quickly
Deficits in short-term memory, problem solving and general academic functioning

22. Postconcussion Syndrome
Management includes making an effort to treat the symptoms. The athlete should not be allowed to return to play until all symptoms have resolved.

23. Second Impact Syndrome
Occurs because of rapid swelling and herniation of the brain after a second head injury that occurs before the symptoms of a previous head injury have resolved. It may not take a blow to the head, it may be to the chest or the back. The symptoms occur because a disruption of the brain’s blood autoregulatory system leads to swelling of the brain, which significantly increases intracranial pressure, and to herniation.

24. Second Impact Syndrome
Signs include the athlete not losing consciousness, and may looked stunned. The athlete may remain standing and be able to leave the playing surface under his or her own power. Conditions will worsen rapidly, with dilated pupils, loss of eye movement, loss of consciousness leading to coma, and respiratory failure.

25. Second Impact Syndrome
This is a life threatening emergency that must be addressed within approximately five minutes by dramatic life-saving measures performed in an emergency care facility. Prevention is the best way to treat this emergency. Do not allow an athlete to return too soon to competition.

26. Concussion Recommendations
According to the Vienna Concussion Conference Recommendations, athletes should complete the following step-wise process prior to return to play following concussion:
Removal from contest following signs and symptoms of concussion
No return to play in current game
Medical evaluation following injury
Rule out more serious intracranial pathology

27. Concussion Recommendations
Step-wise return to play
No activity - rest until asymptomatic
Light aerobic exercise
Sport-specific training
Non-contact drills
Full-contact drills
Game play

28. Tooth Fractures
Any impact to the lower or upper jaw or direct trauma can potentially fracture the teeth. Three types of fractures can occur
Uncomplicated crown fracture
Complicated crown fracture
Root fracture

29. Tooth Fractures
Uncomplicated fracture there is a small portion of the tooth broken, no bleeding and the pulp chamber is not exposed
Complicated fracture there is bleeding and the pulp chamber is exposed and there is great deal of pain.
Root fracture occurs below the gum line so diagnosis is difficult. X-Ray needed and it is very painful.