1. HEAD INJURIES

2. Prevention Prevalent in contact and collision sports
Education and communication
Protective equipment
Silent epidemic

3. Anatomy

4. Amnesia RETRO-GRADE ANTERO-GRADE What did you eat for breakfast?
What team are we playing?
What is the score of the game?
Injury
ANTERO-GRADE
How did you get off of the field?
Repeat digits in reverse order
Serial-7 Test
5-word Recall

5. Assessment Special Tests Neurologic exam Eye function SCAT-2
Pupils equal reactive to light (PEARL)
Eye tracking
Nystagmus (bumpy movement)
Blurred vision

6. Skull Fracture Cause: Signs & Symptoms: Blunt trauma
Severe headache and nausea
Palpation may reveal deformity

7. (cerebrospinal fluid)
Skull Fracture
Signs & Symptoms: (con’t)
Care:
Immediate hospitalization
Racoon Eyes
Battle’s Sign
Halo Sign
(cerebrospinal fluid)

8. Concussion Mild Traumatic Brain Injury:
“Immediate and transient post-traumatic
impairment of neural function
with no focal lesions found on neuroimaging”

9. Concussion Causes: Signs & Symptoms: Direct blow
Acceleration/deceleration forces
Shaking of the brain
Signs & Symptoms:
Altered consciousness
Amnesia

10. Concussion Signs & Symptoms: (con’t) Confusion Tinnitus Dizziness
Photophobia
Disorientation
Difficulty Concentrating
Amnesia
Nausea
Headache
Blurred vision
Sleep disturbances
Irritability

11. Concussion Care More conservative in recent years
Zurich Guidelines (2009)
SCAT-2 to assess symptoms and cognitive function
Any symptoms: remove from participation
7-step RTP protocol

12. Concussion Care Must be cleared by physician Repetitive concussions:
3-6x more likely after 1st concussion
Cumulative trauma

13. Postconcussion Syndrome
Causes:
Prolonged symptoms following a concussion
Not determined by severity of concussion
May be caused by premature RTP

14. Postconcussion Syndrome
Signs & Symptoms:
Persistent headaches
Impaired memory
Lack of concentration
Anxiety and irritability
Fatigue
Depression
Poor academic performance

15. Postconcussion Syndrome
Care
Brain rest after concussion:
Low lights, low activity
Limit “screen time”
Avoid activities that tax the brain
Reading from paper/book is beneficial
Follow RTP protocol

16. Second Impact Syndrome
Causes:
Hit to head when concussive symptoms still present
Disrupts the brain’s blood autoregulatory system
Rapid swelling and herniation of brain
Second impact may be minimal

17. Second Impact Syndrome
Signs & Symptoms:
Often no LOC
May looked stunned
Within minutes, condition degrades rapidly
Dilated pupils
Loss of eye movement
LOC leading to coma
Respiratory failure

18. Second Impact Syndrome
Care
Life-threatening injury
Immediate referral
Life-saving measures w/in 5 minutes
Best management is prevention
Allow concussions to fully heal before RTP

19. Epidural/Subdural Hematoma
Cause of Injury
Blow to head or skull fracture
Tear meningeal arteries
Blood pressure and hematoma occur rapidly
Subdural
Epidural

20. Epidural Hematoma Signs & Symptoms: LOC followed by period of lucidity
Few signs serious head injury
Gradual progression of S&S
Head pains
Dilation of one pupil (same side as injury)
Deterioration of consciousness
Depression of pulse and respiration
Convulsion

21. Epidural/Subdural Hematoma
Care
Immediate medical attention
CT or MRI is necessary to determine extent of injury
Must relieve pressure to avoid disability or death