1. Sports Concussion: Sideline and Initial Management Jim Fiechtl, MD Assistant Professor: Depts. Of EM and Orthopedics Vanderbilt Bone and Joint Clinic Vanderbilt Bone & Joint

2. Disclosures Unfortunately, I have no financial disclosures to make, but I am always willing to listen. Vanderbilt Bone & Joint

3. Objectives How to recognize? What we are doing on the sideline? Who goes to the ER Vanderbilt Bone & Joint

4. Who is concussed? Vanderbilt Bone & Joint http://i.cdn.turner.com/si/multimedia/photo_gallery/0910/cfb.impact.injuries/images/tim-tebow.3.jpg

5. Who is concussed? Vanderbilt Bone & Joint http://www.cbssports.com/mcc/blogs/entry/24156338/29747154

6. Who is concussed? Vanderbilt Bone & Joint http://theother87.files.wordpress.com/2011/05/youth-soccer.jpg

7. Who does the evaluation? Anyone trained – Means someone has been trained – Coach – Certified Athletic Trainer – Physician – Team Parent Vanderbilt Bone & Joint http://www.trophies2go.com/team-mom-trophy

8. What are we looking for? Lying on the ground/slow to get up – Are they unconscious? Unsteady or wobbly Grabbing their head Dazed, blank look Confused, running wrong plays Vanderbilt Bone & Joint Pocket Concussion Recognition Tool™

9. Lying Motionless If unconscious, assume a cervical spine injury – C-spine control – Activate Emergency Action Plan Take your time – ensure safety Needs to go to Emergency Department Vanderbilt Bone & Joint http://mnhopper1s.files.wordpress.com/2011/10/spine.jpg?w=4 20&h=337

10. Able to Move Take your time – ensure safety Move them to a ‘quiet’ area on the sideline Give the player a few minutes to catch breath Observe Vanderbilt Bone & Joint

11. Sideline Assessment Maddocks’ Questions – What city and stadium? – Opponent? – Month and day? – Remember being injured, score of the game, the play, etc Memory and Cognition – Months, 3 objects, numbers backwards Vanderbilt Bone & Joint

12. Sideline Assessment Brief Neuro Exam – Cranial nerves – Strength – Balance – Cerebellar Vanderbilt Bone & Joint

13. When can they go back in? They’re done for the day. Vanderbilt Bone & Joint

14. Who needs a trip to the ER? Worsening headache or symptoms Drowsy, hard to awaken Repeated vomiting Unusual behavior Seizures Weakness or numbness in arms or legs Slurred speech, unsteady walking Vanderbilt Bone & Joint http://ia.media- imdb.com/images/M/MV5BMjA0NjI0ODgzNF5BMl5BanBn XkFtZTcwMDAxNDUyMQ@@._V1_SY317_CR20,0,214,317 _.jpg Putukian. BJSM 2013;47:285-8.