1. Head Injuries Care & Prevention of Athletic Injuries Ms. Herrera ATC/L

2. Anatomy  Skull is made of 22 bones  Joined together by “sutures” (immovable joints)  Temporal bone is the thinnest aspect.

3. Anatomy Cont’d  CNS is comprised of the brain and spinal cord.  Functions of the…  Cerebrum  Cerebellum  Pons  Medulla Oblongata

4. Anatomy Con’td  Meninges  3 layers  Dura Mater, Arachnoid, and Pia Mater  Subdural space divides the dura and arachnoid space  CSF function?  Suspends the brain  Cushions  Lessons forces

5. General Information  Head injuries occur in…  Contact and collision sports  Examples?  MOI  Direct blow to the head  Impact causing the head to snap in different directions

6. General Signs & Symptoms  Brain injury may result in…  LOC  Track time of LOC  Disorientation  Amnesia  Motor coordination  Balance deficits  Cognitive deficits  If ath has LOC  Must consider C-spine injury

7. History  Can you remember the score or who we played last week? (retrograde amnesia)  Can you remember walking off the field? (antegrade amnesia)  Does your head hurt?  Do you feel nauseous?  Do you have pain in your neck?  Can you move your arms and legs?  Do you remember what happened?

8. Observation  Does the athlete appear disoriented?  Does the athlete have a blank stare?  Does the athlete have incoherent speech?  Does the athlete respond to questions with delay?  Are they walking with imbalance?  Are they unable to focus?  How are they acting emotionally?  Is the athlete’s scalp swollen or bleeding?  Does the athlete have CSF coming out of their ear?

9. Palpation  ATC should palpate the following for obvious deformity…  Neck  Skull

10. Special Tests  Neurological Exam  Eye function  PERRLA  Nystagmus (demonstrate)  Balance Tests  Romberg  BESS  Coordination Tests  Cognitive Tests  Remember these 5 words  Say the months backwards

11. Cranial Nerves  Review handout  Demonstrate

13. Skull FX  MOI: Direct blow to the head.  Examples…  Signs & Symptoms (S&S)  Severe headache  Nausea  Indentation in skull  Blood in ear or nose  “Battle’s sign”  “Racoon eyes”  CSF “Halo sign”  Management  Activate EMS  Refer to neurosurgeon ASAP  Why???

14. Cerebral Concussions  Definition: “Immediate and transient impairment of brain function affecting equilibrium and disrupting consciousness.”

15. Concussions  MOI:  Direct blow  COUP injury: stationary skull hit at a high velocity. Injury on same side.  Counter-coup: Skull moving at high velocity, stops suddenly, and strikes a surface causing damage to the opposing side of impact.  Acceleration/deceleration forces causing the brain to shake.

16. Concussions S&S  Postraumatic Amnesia  Antegrade vs retrograde  Loss of balance  Behavior (not themselves)  Loss of CN function  Diminished neurological function  Confused  Vacant stare  Lack of focus  Delayed Responses  LOC  Emotions out of proportion  Slurred speech

17. Management  LOC, suspect C-Spine  Spine board and transport to ER via EMS  CT Scan  If no LOC  Evaluate on sideline  Track postconcussive signs and symptoms  Monitor  Not released until no s&s are present  Different scales  When to “grade” a concussion?

18. Second-Impact Syndrome  Occurs when an ath sustains a 2 ND blow to the head, while still recovering from a previous concussion.  Second blow can be minimal.  Causes swelling in the brain  ↑ intracranial pressure  Initially, ath appears normal  Moments later….  Mortality rate of 50%  Management?

19. Cerebral Contusion  MOI: Impact with a stationary object  Causes bleeding in the brain.  S&S:  LOC  Headaches  Dizzyness  Nausea  Management: Refer to ER  CT Scan or MRI

20. Epidural Hematoma  Hematoma between the skull and dura mater.  S&S  Severe head pain  Dizziness  Lucid interval  Nausea  Dilation of 1 pupil  Sleepiness  Management: Refer to ER  CT scan  Delayed medical attention can result in death or permanent disability  May be confused for mild concussion.

21. Subdural Hematoma  More common than epidural hematomas  Most common cause of death in athletes  MOI: deceleration/acceleration forces  S&S: same as epidural  Management:  Activate EMS  Emergency!

22. Scalp Injuries  MOI: Blunt trauma causes laceration  Could cause brain injury  S&S:  Profuse bleeding  Makes it difficult to?  Pain  Management: Refer to ER  Requires stitches  CT scan to r/o brain injury