Serious head injuries almost always represent a life-threatening situation ... The S/S of a head/brain injury may not be apparent until hours after the trauma occurs ... – PowerPoint PPT presentation
Serious head injuries almost always represent a life-threatening situation
Must get athlete to the hospital immediately
Within 30 minutes
4 Signs and Symptoms
Altered level of consciousness (LOC)
Pain or pressure in the head
Tingling or loss of sensation in the extremities
Partial or complete loss of movement in any body part
5 Signs and Symptoms cont
Unusual lumps or depressions on the head
Blood or other fluids in the ears or nose
Profuse bleeding from the head
Seizures
Impaired breathing
Impaired vision
6 Signs and Symptoms cont
Nausea or vomiting
Persistent headache
Loss of balance
Ecchymosis
Especially around the eyes or behind the ears
7 Signs and Symptoms cont
The S/S of a head/brain injury may not be apparent until hours after the trauma occurs
Immediate referral to a physician is important for the proper treatment of a serious head/brain injury
8 Primary Assessment
Must be able to recognize and interpret the S/S of a head injury
If an athlete is unconscious ALWAYS assume injury to the neck as well
9 Primary Assessment cont
Without moving the athlete assess the airway
Athlete is breathing
Airway is obstructed
Observe for S/S of head and neck injury
Face color
Skin condition
Pulse
Breathing
Pupils
Edema
Ecchymosis
Deformity
10 Secondary Assessment
Assess mental orientation and memory
What is your name
How old are you
Where are you
What game are you playing
What is the score
What month is it
Who is president
After 5-10 minutes ask the same questions again
11 Secondary Assessment cont
Test for Eye signs
Dilated and/or irregular pupils
Blurred vision
Inability for eyes to accommodate rapidly to light variance
Inability for eyes to track smoothly
nystagmus
12 Secondary Assessment cont
Balance Testing
Stand with eyes closed
Stand on one foot
Stand on one foot with eyes closed
Finger-to-Nose test
Babinski Test
Reflex tested by running a pointed object along the bottom of the foot
Normal response is toe flexion
13 Concussion Classification
There are many ways to classify concussions
Different Grading Scales exist
Cantu (1986)
Colorado Medical Society (1991)
Torg (1991)
American Academy of Neurology (1997)
Guskiewicz/University of North Carolina (1998)
14 General Concussion Classification
Grade I Concussion
Normal consciousness
No memory loss
May elicit mild disorientation
S/S resolve within 5-15 minutes
Most common concussion sustained in sports
15 General Concussion Classification
Grade II Concussion
Normal consciousness
Confusion
Post-traumatic amnesia
Inability to recall events that have occurred since the time of injury
Unsteadiness/Dizziness
Tinnitus
Headache
16 General Concussion Classification
Grade II Concussion cont
Post-concussion Syndrome
Difficulty concentrating
Recurring headaches
Irritability
S/S may last several weeks
Athlete may not return to play until all S/S are resolved
17 General Concussion Classification
Grade III Concussion
Normal consciousness
Confusion
Post-traumatic amnesia
Retrograde amnesia
Inability to recall events that occurred before the injury
18 General Concussion Classification
Grade III Concussion cont
Unsteadiness/Dizziness
Tinnitus
Headache
Confusion
19 General Concussion Classification
Grade III Concussion cont
This athlete must be referred to a physician for a thorough examination
An intracranial lesion may be present
Results in intracranial bleeding
Causes a gradual increase in intracranial pressure
20 General Concussion Classification
Grade IV Concussion
Loss of consciousness
Referred to as Paralytic Coma
Return to consciousness usually within a few seconds or minutes
Post-traumatic amnesia
Retrograde amnesia
Post-concussion Syndrome
21 General Concussion Classification
Grade IV Concussion cont
While returning to consciousness the athlete will display states of
Stupor
Confusion
Delirium
Medical Emergency
Suspect neck injury also
Spine board the athlete
Transport the athlete to the hospital immediately
22 General Concussion Classification
Grade V Concussion
Paralytic Coma
Secondary cardio-respiratory collapse
The Glasgow Coma Scale is used to determine the state of the athlete
23 Glasgow Coma Scale Lowest score 3 Highest score 15 24 General Concussion Classification
Grade VI Concussion
Death
25 Secondary Conditions Associated with Concussions
Intracranial Hemorrhage
Skull Fracture
Epidural Hemorrhage
Subdural Hemorrhage
Intracerebral Hemorrhage
Cerebral Hyperemia
Cerebral Edema
Seizures
Migraine Headaches
26 Intracranial Hemorrhage
Intracranial bleeding
Venous bleeding
Slow insidious onset
Arterial bleeding
S/S apparent within a few hours
27 Intracranial Hemorrhage
Early S/S
Severe head pains
Dizziness
Nausea
Unequal pupil sizes
Sleepiness
Severe S/S
Deteriorating consciousness
Neck rigidity
Slow pulse
Slow respiration
Convulsions
28 Epidural Hemorrhage
A blow to the head causes a tear in one of the arteries of in the dural membrane that covers the brain
Hematoma forms extremely fast
Within 10 20 minutes after injury
29 Epidural Hemorrhage
Requires surgery to relieve the pressure created by the hemotoma
Death or permanent disability may result
30 Subdural Hemmorhage
A blow to the head causes a tear in one of the veins located between the dura mater and the brain
Hematoma forms slowly
S/S may not be appear until hours after injury
31 Subdural Hemmorhage
Commonly occurs following a contrecoup injury
May or may not require surgery
32 Intracerebral Hemorrhage
A blow to the head may cause bleeding within the brain itself
Usually results due to a compressive force applied to the brain
Rapid deterioration in neurological function
Requires immediate hospitalization
33 Cerebral Hyperemia
Vasodilation of cerebral blood vessels following a head/brain injury
Causes an increase in intracranial blood pressure
Develops within minutes after the injury
S/S headache vomiting sleepiness
S/S usually resolve within 12 hours after the injury
34 Cerebral Edema
Localized swelling of the brain at the injury site
Develops within 12 hours after the injury
S/S headache seizures (occasionally)
Cerebral edema may remain for as long as 2 weeks following the injury
35 Criteria to Return to Play
Normal neurological function
Normal vasomotor functions
Normal balance
Free of headaches
Free of lightheadedness
Free of dizziness
Free of seizures
36 Criteria to Return to Play Mild Concussion
First Concussion
Return to play if asymptomatic
Second Concussion
Must be asymptomatic for 1 week
Third Concussion
Terminate season
May play next year if asymptomatic
37 Criteria to Return to Play Moderate Concussion
First Concussion
Must be asymptomatic for 1 week
Second Concussion
Must be asymptomatic for 1 month
Third Concussion
Terminate season
May play next year if asymptomatic
38 Criteria to Return to Play Severe Concussion
First Concussion
Must be asymptomatic for 1 month
Third Concussion
Terminate season
May play next year if asymptomatic
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