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Concussion Assessment
Vidal Mora, L.A.T., A.T.C.
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Defining Concussion a traumatically induced transient disturbance of brain function and involves a complex pathophysiologic process. Concussion is a subset of mild traumatic brain injury that is generally self- limited and at the less severe end of the brain injury spectrum.
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Suspecting Concussion
Mechanism: most common is head contact or whiplash Direct Blows (Struck in head with object) (Moving head strikes fixed object) Coup injury that occurs on the same side of the brain as the impact Contrecoup injury that occurs on opposite side of the brain from where impact occurred
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Keep in mind of… History of Concussions History of Migraines
Cerebral Contusions Hematomas- intracranial, epidural, subdural Lacerations Spine Injuries Skull Fractures
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Equipment for Assessment
Small Kit/backpack Cervical Collar Pen Light Pen/Notepad Watch/timer Blood Pressure Cuff/Stethoscope Reflex Hammer Ophthalmoscope Otoscope Concussion Checklist Cheat Sheet. Standardized Assessment of Concussion Form
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SCAT 5 Form Sport Concussion Assessment Tool
For medical professionals Used for assessment after first aid/emergency care priorities are completed Modify if need be Self-explanatory/easy/free SCAT5.full.pdf Child Form – ages 5-12 childscat5.full.pdf
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Immediate Assessment Red Flags Observable signs
Memory Assessment Questions Examination Cervical Spine Assessment
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SCAT 5 Neck pain or tenderness Double Vision
Weakness or tingling/burning in arms or legs Severe or increasing headache Seizure or convulsion Loss of consciousness Deteriorating conscious state Vomiting Increasingly restless, agitated or combative
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SCAT 5
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Brief Memory Assessment/SCAT5
Modified Questions What happened? What’s your name? Where are you? What time is it?
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Amnesia Retrograde Amnesia Anterograde Amnesia
No memory for things that occurred before the injury Example: Patient does not know what they ate for breakfast. Anterograde Amnesia No memory for things that occurred after the injury Example: Patient does not know who helped them up off the ground
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SCAT5
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Initial Assessment Management
Check ABCs/ Heart Function Mental Status Deteriorating, abnormal neurological findings, and/or worsening symptoms Immediate transfer to ED More serious brain injury can be excluded Physical Exam – Rule Out Spine Injury Spine injury CAN be ruled out More detailed history of injury and examination with symptoms, cognitive, balance assessments, and neurological examination should be initiated When Clinical Assessment can takes place If spine injury cannot be eliminated Immobilize neck and 911
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Clinical Assessment /Side Notes
Patient Background Symptom Evaluation Cognitive Screening Neurological Screening Delayed Recall Decision/Plan Preferable to do in a quiet, more calm area Without distractions Resting State Also if patient is accompanied make sure the company does not try to answer questions for patient Time of complete assessment can’t be done in less than 10 mins
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Pre-Clinical Assessment
Vital Signs Height Weight Temperature Pulse/HR BP Respiration Pain
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Background Document subjective material
Patient background and information Past history Neurological diagnoses Medicine
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Symptoms - Checklist Two Primary: Disturbances in level of consciousness, and posttraumatic amnesia Blurred vision Confusion Dizziness Drowsiness Excess Sleep Easily Distracted Fatigue/Low Energy Feel “in a fog” Feel “slowed down” Headache Inappropriate Emotions Irritability Loss of Consciousness Loss of Orientation Memory Problems Nausea Nervousness Personality change Poor balance/coordination Poor Concentration Pressure in Head Ringing in Ears Sadness Seeing Stars Sensitivity to Light Sensitivity to Noise Sleep Disturbance Vacant stare/Glassy eyed Vomiting
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SCAT5
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SCAT 5
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SCAT5
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SCAT 5
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Neurological Screening/SCAT5
Cranial Nerves Olfactory Optic Oculomotor Trochlear Trigeminal Abducens Facial Vestibulocochlear Glossopharyngeal Vagus Accessory Hypoglossal
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Special Tests SCAT5 Finger nose coordination test Tandem gait
Appendicular coordination Rapid alternating movements Precision finger tap Heel-shin overshoot Tandem gait Romberg test (mBESS) testing (Pictured)
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SCAT 5
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SCAT5
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Thank You!
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