1. Head Trauma in Sports Injuries
McKay Fall 2017

2. Learning Objectives Define a concussion and asses the severity
Understand the key signs and symptoms of a concussion, and how to provide appropriate care for a concussed athlete.
Develop a plan of treatment based on that assessment
Form a plan for return to competition for the athlete

3. “If ever I need a brain transplant, I want one from a sports writer, ‘cause I know it’s never been used.”
Joe Paterno, Penn State Football Coach

4. What is a Concussion
A concussion by definition, means “to shake violently.”
A blow to the head or to another part of the body, with force transmitted to your head, that causes the brain to shake inside the skull and result in “EVEN A BRIEF AND MILD” alteration in brain function is considered a concussion.
Concussion can be caused by a blow to the head, or to another part of the body with the force transmitted to the head. Most concussions are caused by a rapid acceleration or deceleration of the brain within the skull.

5. Mental Status Exam Checklist to Identify a Concussion
Affect/appearance
Orientation (time, day/date, place, situation)
Memory (immediate recall, recent, remote)
Intellect (calculations)
Judgment

6. PREVIOUS CONCUSSION CLASSIFICATION (Prior to 2011-12)
Grade 1: Confusion without amnesia, no loss of consciousness.
Grade 2: Confusion with amnesia, no loss of consciousness (not lasting longer than TWO- THREE minutes)
Grade 3: Loss of consciousness (lasting longer than 3 minutes
This is the OLDER version of how concussions where defined and identified.
DO NOT COPY THIS SLIDE

7. TODAY’s Concussion Classification
A CONCUSSION is a CONCUSSION!
Standing Management and protocol procedures will be followed each individual case.

8. Signs/Symptoms of a Concussion
Amnesia (memory recall)
Confusion or appearing dazed
Headache or head pressure
Loss of consciousness
Balance difficulty
Dizziness
Double or blurry vision
Fatigue or sleep issues
Sensitivity to light or sound
Nausea, vomiting, or loss of appetite
Irritability or changes in personality
Feeling sluggish, foggy, groggy
Concentration or focusing problems
Slow reaction times

9. Signs and Symptoms that Indicate an Athlete Needs Emergency Evaluation
I 1. Impairment of consciousness (or changes in mental status or behavior, increasing or continued)
Need 2. Nausea and vomiting
My 3. Motor activity, decreased, unequal, or pathologic posturing.
Very 4. Vital Signs (ventilation, pattern, blood pressure, or decreasing pulse rate)

10. Head 6. Headaches, Increasing Protection 7. Pupillary inequality
Special 5. Seizures
Head 6. Headaches, Increasing
Protection 7. Pupillary inequality
Important: Remember, the forces that cause a head injury may also produce cervical spine injuries.

11. Sports Associated with a High Risk of Concussions
Auto Racing
Boxing
Equestrian Sports
Football
Ice Hockey
Lacrosse
Martial Arts
Motorcycle Racing
Rugby
Skating
Rollerblading
Skiing
Soccer (goalie)
Pole Vaulting

12. Two Sports with the Highest Rate
Boxing/UFC
Football

13. Zachary Lydstett Law

14. Summary of Concussion and Preview for Treatment
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15. What Do I Do if I Suspect a Concussion?
Any athlete suspected of a concussion should be removed from the game or practice immediately.
Continue to monitor the player after your initial evaluation.
Make sure the athlete is supervised for at least one or two hours after you suspect a concussion.
Do not allow the athlete to return to play until you have received written clearance from a licensed health care provider trained in the evaluation and management of brain injuries.
If you suspect a concussion remove the athlete from play immediately. Continue to monitor the athlete and make sure the parents are notified. Make sure the athlete is supervised for at least one or two hours after you suspect a concussion.
Do Not allow the athlete to return to play until you have received written clearance from a licensed health car provider trained in the evaluation and management of brain injuries.

16. Health Care Providers
What health care providers are licensed and trained in the evaluation and management of brain injuries:
Medical Doctors (MD)
Doctor of Osteopathy (DO)
Advanced Registered Nurse Practitioner (ARNP)
Physicians Assistant (PA)
Licensed Certified Athletic Trainers (ATC)
This is a current list of which health care providers are licensed in the State of Washington with training in the evaluation and management of brain injuries.

17. WHAT SHOULD A COACH DO WHEN A CONCUSSION IS SUSPECTED?
ACTION PLAN
WHAT SHOULD A COACH DO WHEN A CONCUSSION IS SUSPECTED?

18. ACTION PLAN Remove the athlete from play.
Look for the signs and symptoms of a concussion if your athlete has experienced a bump or blow to the head. Athletes who experience signs or symptoms of concussion should not be allowed to return to play. When in doubt, keep the athlete out of play.

19. ACTION PLAN
Ensure that the athlete is evaluated right away by an appropriate health care professional.
Do not try to judge the severity of the injury yourself. Health care professionals have a number of methods that they can use to assess the severity of concussions. As a coach, recording the following information can help health care professionals in assessing the athlete after the injury:
Cause of the injury and force of the hit or blow to the head
Any loss of consciousness (passed out/knocked out) and if so, for how long
Any memory loss immediately following the injury
Any seizures immediately following the injury
Number of previous concussions (if any)

20. ACTION PLAN
Inform the athlete’s parents or guardians about the possible concussion and direct them to the Parent Information Sheet in the Co- Curricular Athletic Handbook (also available on the district athletic web site) . Make sure they know that the athlete should be seen by a health care professional experienced in evaluating for concussion.

21. ACTION PLAN
Allow the athlete to return to play only with permission from a LICENSED health care professional with experience in evaluating for concussion.
A repeat concussion that occurs before the brain recovers from the first can slow recovery or increase the likelihood of having long-term problems.
Prevent common long-term problems and the rare second impact syndrome by delaying the athlete’s return to the activity until the player receives appropriate medical evaluation and approval for return to play.

22. Licensed Health Care Providers
What licensed health care providers are trained in the evaluation and treatment of concussions/brain injuries and authorized to allow the athlete to return to play?
Medical Doctors (MD)
Doctor of Osteopathy (DO)
Advanced Registered Nurse Practitioner (ARNP)
Physicians Assistant (PA)
Licensed Certified Athletic Trainers (ATC)
Research is currently being done to determine which other licensed health care providers may have sufficient training to qualify to authorize return to play.

23. Return To Play Must be symptom free without medication for 24 hours.
Day 1: Low level physical activity (light Jogging, Stationary Bike, Walking)
Day 2: Moderate Levels of Physical Activity (Weightlifting)
Day 3: Heavy non-contact physical activity (Sports Specific Drills)
Day 4: Non-contact sports specific practice.
Day 5: Unrestricted Full contact practice
Satisfactory Neuro-cognitive Scores Compared To Baseline
No earlier than hours post injury.
May only move 1 step per day.
Any symptoms require starting the RTP process over.

24. summary
If you think your athlete has sustained a concussion… take him/her out of play, and seek the advice of a health care professional experienced in evaluating for concussion.

25. Other BRAIN Related Injuries
There are many other brain related issues that can occur with concussions.

26. What is Second Impact Syndrome?
Second Impact syndrome is the rapid development of diffuse brain swelling in the setting of a recent head injury followed by a second impact to the head.
Only impacts people under the age of 23

27. Preston Plavertes LINK https://www.youtube.com/watch?v=F4foY1EtmKo

28. Leading Cause of Death From Athletic Head Injury
* Intracranial hemorrhage- which is defined as the leaking of blood within the brain, due to a result of a concussion/head injury

29. Immediate Management of an Athlete who has Collapsed
Protect the cervical spine
ABCs for CPR
Hyperventilation to reduce CO2
Transport to medical facility
Evaluation to include CT or MRI scans

30. Signs of a Temporal Lobe Herniation
Increasing blood pressure and decreasing pulse
Contralateral himparesis and ipsilateral dilated pupil– occurs with unilateral temporal lobe herniation
Bilateral pyramidal tract signs- paresis/paralysis with bilateral dilated pupils
Impairment of respiration and consciousness

31. Signs of Basilar Skull Fracture
Bruises or bleeding behind the ear, in ear canal, and/or around the eye
Blood or CSF exiting from the ear or nose
Hearing loss
Lack of smell
Facial paralysis