Head

1
Head
2
Skull Fracture

• Etiology
• Blunt trauma or a fall from a height
• Signs Symptoms
• Severe headache and nausea palpation may reflect
  a defect such as a skull indentation there may
  be blood in the middle field, blood in the ear
  canal, bleeding through the nose, ecchymosis
  around the eyes (raccoon eyes) or ecchymosis
  behind the ears (battle sign) cerebral spinal
  fluid may appear in the ear canal and nose
• Treatment
• Hospitalization and neurosurgeon referral

3
Cerebral Concussions(Mild Head Injuries)

• Etiology
• Blunt trauma or a fall from a height
• Signs Symptoms
• Headache, tinnitus, nausea, irritability,
  confusion, dizziness, loss of consciousness,
  posttraumatic (anterograde) amnesia, retrograde
  amnesia, concentration difficulty, blurred
  vision, photophobia, sleep disturbance
• Treatment
• Athlete is removed from play. May return to play
  if asymptomatic for 20 minutes.

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Head Injury Guidelines
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Post-Concussion Syndrome

• Etiology
• Poorly understood condition that occurs following
  a concussion
• Signs Symptoms
• Athlete complains of a range of post-concussion
  problems, including persistent headache, impaired
  memory, lack of concentration, anxiety and
  irritability, giddiness, fatigue, depression and
  visual disturbances. These symptoms may begin
  immediately or within several days following the
  initial trauma and may last for weeks or even
  months before resolving.
• Treatment
• Athlete is removed from play until all symptoms
  of this condition have resolved.

6
Second Impact Syndrome

• Etiology
• Rapid swelling and herniation of the brain after
  a second head injury that occur before the
  symptoms of a previous head injury have resolved.
  The second impact may be relatively minor and, in
  some cases, may not even involve a blow to the
  head
• Signs Symptoms
• Often, the athlete does not even lose
  consciousness and may look stunned. The athlete
  may remain standing and be able to leave the
  playing field under his or her own power.
  However, within 15 seconds to several minutes,
  the athletes condition worsens rapidly, with
  dilated pupils, loss of eye movement, loss of
  consciousness leading to coma, and respiratory
  failure. This is a life-threatening situation!
• Treatment
• Emergency hospitalization. The best treatment is
  prevention.

7
Cerebral Contusion

• Etiology
• Blunt trauma
• Signs Symptoms
• Athlete may experience a loss of consciousness
  but subsequently becomes very alert and
  talkative. A neurological exam will be normal,
  however, symptoms such as headaches, dizziness,
  and nausea will persist
• Treatment
• Hospitalization

8
Epidural Hematoma

• Etiology
• A blow to the head or a skull fracture causing a
  tear of the menigeal arteries which are embedded
  in the bony grooves of the skull
• Signs Symptoms
• Athlete may experience a loss of consciousness
  but subsequently becomes lucid and show few or
  none of the symptoms of a serious head injury.
  Gradually symptoms begin to worsen and the
  athlete begins to experience severe head pain
  dizziness, dilation of the pupil (usually on the
  same side of the injury), and sleeplessness. This
  can degrade into a life-threatening situation.
• Treatment
• Hospitalization

9
Subdural Hematoma

• Etiology
• Occur more frequently than an epidural hematoma
  results from acceleration/deceleration forces
  that tear vessels that bridge the dura mater and
  the brain.
• Signs Symptoms
• Athlete may loose consciousness the athlete may
  experience severe headache dizziness, dilation
  of the pupil (usually on the same side of the
  injury), and sleepiness. This can degrade into a
  life-threatening situation.
• Treatment
• Hospitalization

10
Malignant Brain Edema Syndrome

• Etiology
• Occurs within minutes to hours after head trauma
  and is caused by an intracerebral clot that
  results in diffuse brain swelling with little or
  no brain injury.
• Signs Symptoms
• Rapid neurologic deterioration from a normal
  alert state that progresses to a coma and
  occasionally death.
• Treatment
• Emergency hospitalization

11
Migraine Headaches

• Etiology
• Athlete has a history of repeated minor blows to
  the head or who has sustained a major cerebral
  injury the exact cause is unknown, but the
  condition is believed to be a vascular disorder
• Signs Symptoms
• Flashes of light, blindness in half the field of
  vision (hemianopia), and paresthesia thought to
  be caused by vasoconstriction of intercerebral
  vessels. The athlete complains of a severe
  headache that is diffused throughout the head and
  often accompanied by nausea and vomiting. There
  is evidence of a familial predisposition.
• Treatment
• Medication

12
Scalp Injuries

• Etiology
• Blunt or penetrating trauma
• Signs Symptoms
• Possible bleeding, pain, and point tenderness
• Treatment
• Pressure with a sterile gauze, cleanse the wound
  thoroughly, then dress. Possible physician
  referral.

13
Mandible Fracture

• Etiology
• Direct blow
• Signs Symptoms
• Deformity, loss of normal occlusion of the teeth,
  bleeding around the teeth, lower lip anesthesia
• Treatment
• Immobilize the jaw with an elastic bandage,
  physician referral

14
Mandible Dislocation

• Etiology
• Side blow to an open mouth
• Signs Symptoms
• Locked in an open position, jaw movement almost
  impossible, overriding malocclusion of the teeth
• Treatment
• Immobilize the jaw with an elastic bandage and
  ice, physician referral, soft diet, and NSAIDs

15
Temporomandibular Joint Dysfunction

• Etiology
• Forward translation of the jaw
• Signs Symptoms
• Headache, earache, vertigo, inflammation, neck
  pain
• Treatment
• Strengthening exercises for hypermobility
  mobilization exercises for hypomobility
  custom-fitted mouthpiece

16
Zygomatic Complex (Cheekbone) Fracture

• Etiology
• Direct blow
• Signs Symptoms
• Deformity, nosebleed, seeing double (diplopia),
  numbness
• Treatment
• RICE, physician referral

17
Maxillary Fracture

• Etiology
• Direct blow
• Signs Symptoms
• Pain while chewing, malocclusion, nosebleed,
  double vision (diplopia), numbness in the lip and
  cheek
• Treatment
• RICE, immobilize, physician referral

18
Facial Laceration

• Etiology
• Direct impact with a sharp object or by an
  indirect compressive force
• Signs Symptoms
• Pain, substantial bleeding, obvious tearing,
• Treatment
• Pressure with a sterile bandage, dress the wound,
  possible physician referral

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Tooth Fracture

• Etiology
• Any type of impact
• Signs Symptoms
• Possible bleeding, broken tooth
• Treatment
• May not require immediate treatment, if the tooth
  is not sensitive, the athlete can play. Place
  tooth in a plastic bag and refer to a dentist.
  Must play with a mouth guard.

20
Tooth Subluxation,Luxation, Avulsion

• Etiology
• Any type of impact
• Signs Symptoms
• Tooth is loosened or dislodged little or no
  pain
• Treatment
• May not require immediate treatment, if the tooth
  is not sensitive, the athlete can play. Place
  tooth in a plastic bag and refer to a dentist.
  Must play with a mouth guard.

21
Nasal Fracture andChondral Separation

• Etiology
• Direct blow from the side or straight frontal
  force
• Signs Symptoms
• Profuse hemorrhage, swelling, deformity,
  palpation will reveal abnormal mobility and
  crepitus
• Treatment
• Ice and compression, x-ray referral, protection

22
Nosebleed (Epistaxis)

• Etiology
• Direct blow
• Signs Symptoms
• Profuse bleeding, possible nasal pain
• Treatment
• Ice and compression, possible doctor referral

23
Auricular Hematoma (Cauliflower Ear)

• Etiology
• Compression or shearing injury
• Signs Symptoms
• Hemorrhage and fluid accumulation
• Treatment
• Apply some friction reducing agent (petroleum
  jelly), the athlete must wear head gear. If the
  ear is hot, apply ice

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Rupture of the Tympanic Membrane

• Etiology
• Fall or slap to the unprotected ear
• Signs Symptoms
• Loud pop followed by pain in the ear nausea,
  vomiting, and dizziness loss of hearing and a
  visible tearing of the membrane
• Treatment
• Small to moderate tears usually heel
  spontaneously in one to two weeks. Infection can
  occur and must be continually monitored. Possible
  physician referral

25
Orbital Hematoma (Black Eye)

• Etiology
• Direct blow
• Signs Symptoms
• Ecchymosis and pain
• Treatment
• Ice and compression, athlete should not blow
  their nose due to the possible increase in eye
  hemorrhage

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Orbital Fractures

• Etiology
• Direct blow from the side or straight frontal
  force
• Signs Symptoms
• Diplopia, restricted eye movement, downward
  displacement of the eye, pain, swelling,
  hemorrhage, numbness
• Treatment
• Physician referral, antibiotics, possible surgery

27
Foreign Body in the Eye

• Etiology
• Any circumstance where there are particles and no
  eye protection
• Signs Symptoms
• Pain and disability
• Treatment
• Flush with water

28
Corneal Abrasions

• Etiology
• Abrading force, usually from a foreign body in
  the eye
• Signs Symptoms
• Pain, watering of the eye, photophobia, eyelid
  spasm
• Treatment
• Cover eye with a patch, physician referral

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Heart Contusion

• Etiology
• When the heart is compressed between the sternum
  and the spine by a strong outside force
• Signs Symptoms
• Severe shock, heart pain, certain arrhythmias,
  decreased cardiac output
• Treatment
• Medical emergency, must be transported to the
  hospital as quickly as possible, may need to
  begin CPR, treat for shock

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Sudden Death Syndromein Athletes

• Etiology
• Usually a caused by some congenital
  cardiovascular abnormality, the three most
  prevalent being hypertrophic cardiomyopathy,
  anomalous origin of the coronary artery, and
  Marfans syndrome
• Signs Symptoms
• Chest pain or discomfort during exertion, heart
  palpitations or flutters, syncope, nausea,
  profuse sweating, heart murmurs, shortness of
  breath, malaise, and fever
• Treatment
• Prevention through counseling, screening, and
  early identification of preventable causes of
  sudden death.
• Medical emergency, must be transported to the
  hospital as quickly as possible, may need to
  begin CPR

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Head Evaluation

• HOPS
• History
• Observation
• Palpation
• Special tests

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Head Evaluation

• Neuralogic exam
• Cerebral Function - Questions that assess general
  affect
• Whats your name?
• What happen?
• Cerebral Function - Questions that assess level
  of consciousness
• Where are you?
• What time (day) is it?
• Whats the score?
• Cerebral Function - Questions that assess
  intellectual performance
• Count backward from 100 by 7s.
• Months backward.
• Cerebral Function - Questions that assess
  emotional status
• Are they being erratic?

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Head Evaluation

• Neuralogic exam
• Cerebral Function - Questions that assess thought
  content
• Memorize three words.
• Cerebral Function - Questions that assess sensory
  interpretation
• Blurred vision?
• Hearing problems.
• Cerebral Function - Questions that assess
  language skills
• Slurred speech.
• Speech impared?
• Reflex testing
• Sensory (dermatome) testing
• Pupil response
• PEARL (Pupils equal and reactive to light)

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Head Evaluation

• Cranial Nerve Function
• Sense of smell (I. Olfactory)
• Eye tracking (II. Optic, III. Oculomotor, IV.
  Trochlear, VI. Abducens)
• Imitations of facial expressions (V. Trigeminal,
  VII. Facial)
• Biting down (V. Trigeminal)
• Balance (VIII. Vestibulocochlear)
• Hearing (VIII. Vestibulocochlear)
• Swallowing (IX. Glossopharyngeal, X. Vagus, XI.
  Accessory, XII. Hypoglossal)
• Strength of shoulder shrugs (XI. Accessory)
• Speak (XII. Hypoglossal, X. Vagus)
• Tongue protrusions (XII. Hypoglossal)

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Head Evaluation

• Cerebellar Function
• Finger to nose
• Finger to examiners finger
• Drawing alphabet in the air with the foot
• Heel-toe walking
• Rhombergs Balance Test eyes shut with one foot
  in the air