Head Injuries

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Head Injuries
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Managing the Unconscious Athlete

• Why is this so scary?
• Can not collect symptoms so must rely on signs
• Always treat as though have cervical spine injury
• Always stay calm

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Mechanisms for Rendering an Athlete Unconscious

• Blow to head
• Diabetic Coma
• Hypoglycemia
• Electric Shock
• Heat Illness
• Drowning

• Psychogenic Shock
• Syncope
• Illness
• Substance Abuse
• Epileptic Siezures
• Rhabdomyolysis
• Others?

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Remember what you have learned thus far!!

• Check
• Call
• Care

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Conduct life-threatening measures

• Treat severe bleeding
• CPR
• AED

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History

• Know/get past medical history
• Mechanism
• If you missed, what should you do?

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Inspection

• Otorrhea
• Rhinorrhea
• Battles Sign
• Raccoon Eyes
• Body Position
• Decorticate rigidity
• Arms flexed, legs extended
• Decerebrate rigidity
• Arms legs extended
• Swelling, Deformity, Bleeding, Discoloration

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Determine Quality of Life

• Pulse
• Respirations
• Pupils
• Blood Pressure
• Record with time

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Establish State of Consciousness

• Glasgow Coma Scale
• Coma Definition
• Assesses depth and duration of coma
• Grades a wide variety of conditions

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Glasgow Coma Scale
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Head Injury Classification Scores

• Sever Head Injury
• Moderate Head Injury
• Mild Head Injury

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Palpation

• Head to toe evaluation
• General information seeking
• Head structures
• Cervical structures
• Upper Extremity
• Arms
• Chest
• Abdomen
• Lower Extremity

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Oh no, What do I do?

• STAY CALM
• Know that you are in control of the controllable
  but YOU CANNOT DICTATE THE OUTCOME
• Be the leader
• Practice, Practice and more PRACTICE
• SOMEONES LIFE MAY BE IN YOUR HANDS

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Concussions
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Definition

• Clinical syndrome characterized by immediate and
  transient impairment of neurological function
  secondary to mechanical forces
• Statistic on Brain Injury
• 750,00 total injuries
• 85,000 brain injuries
• NFL 3.5 brain injuries/game
• 10 college and 20 HS football players suffer
  brain injuries
• 5 soccer players suffer brain injuries

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Mechanism

• Coup Injury
• Contrecoup Injury
• Types of forces causing brain injury

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Acute Concussion Sign and Symptoms

• Headache
• Consciousness Levels
• Memory Impairment
• Retrograde amnesia
• Anterograde amnesia
• Cognitive Function Deficits
• Behavioral Changes
• Balance and Coordination

• Tinnitis
• Pupil Size
• Aniscoria
• Nystagmus
• Vision Acuity
• Nausea
• Pulse
• Blood Pressure
• Respirations

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Injury Classification

• Epidemiology
• American Academy of Neurology Grading Scale
• Grade 1
• Grade 2
• Grade 3
• Advantage/Disadvantages
• Cantu Evidence Based Grading Scale
• Grade 1
• Grade 2
• Grade 3
• Advantage/ Disadvantages

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NATA Position Statement

• Avoid grading scales
• Focus on Recovery
• Is the athlete symptomatic ofor asymptomatic
• Once asymptomatic focus on progresssion

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Post-concussion Symtpoms

• Photophobia
• Sensitivity
• Seeing stars or flashing lights
• Poor concentration
• Irritability
• Depression
• Anxiety
• Fatigue
• Headache
• Sleep disturbance

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Post-concusion Assessment

• Mental Testing Assessment
• Postural-stability Tests
• Neuropsychological Tests

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Post-concussion Assessment

• Mental Status Testing
• Standardized Assessment of Concussion Test
• Orientation
• Immediate memory
• Concentration
• Delayed recall
• Also measures
• Strength
• Sensation
• Coordination
• Neurological exam
• LOC and anmnesia also recorded
• Max score
• Low scores?
• Need good baseline data

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Post-concussion Assessment

• Postural-stability Assessment
• Romberg or Stork Tests
• Balance Error Scoring System (BESS)
• 3 stance positions
• 2 different surfaces
• Test Position
• Count errors
• What counts as an error
• There is a practice effect from multiple trials

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Post-concussion Assessment

• Neuropsychological Testing
• Most require licensed and board certified
  psychologist
• Tests include
• Attention
• Concentration
• Memory function

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Return to Play Decisions

• Some guideline require 7 day of symptom free
• Begins with progression
• SAC
• Both rest and exertional assessment
• All tests baseline or better
• NATA Position Statement
• Minimum 7 days after asymptomatic

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Guidelines for RTP after several Concussions
Prentice, Principles of AT, 13th ed
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When do you refer to physician?

• Any LOC
• Decr. LOC
• Amnesia 15 min
• Decr. neurological function
• Decr. or irregularity of respirations
• Decr. Or irregularity of pulse
• Increase in BP
• Mental status changes
• Seizures

• Unequal, unresponsive or dilated pupils
• Cranial nerve deficits
• Injuries associated with spine, skull fractures
• Subsequent to Initial Eval
• Motor deficits
• Sensory deficits
• Balance deficits
• Cranial nerve deficits
• Post-concussion symptoms that worsen

Indicates that patient be transferred
immediately to nearest emergency facility
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Secondary Impact Syndrome

• What is it?
• Signs
• Treatment

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Epidermal Hematoma

• Bleeding between scalp and skull
• Little concern unless have S/S of head spine
  injuriy

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Epidural Hematoma

• Etiology
• Associated with skull fractures
• Tear in meningeal arteries
• S/S
• Management
• Medical Emergency

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Subdural Hematoma

• Etiology
• Acceleration/deceleration force
• 3 kinds
• S/S
• Management
• Referral

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Skull Fracture

• Mechanism
• Blunt trauma
• Types of fractures
• S/S
• Management
• ABCs
• CSF leakage

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Putting it Together

• History
• Ask people
• Establish level of consciousness
• Headache
• Senses
• Memory
• Inspection
• LOC
• ABCs
• Head Position
• Skull
• Mastoid Process
• Eyes, ears, nose
• Body Position
• Movements
• Behavior
• Facial expressions

• Palpation
• Head/Scalp
• Cervical spine
• Soft Tissue
• Vital signs
• Functional Tests
• Cognitive Function (Subjective)
• Cognitive Function (Objective)
• SAC
• Balance and Coordination
• Neurological Tests
• Dermatomes
• Myotomes
• Continue Monitoring
• Every 5 minutes