Transcript Document
Head Injuries Objectives Describe the anatomy of the head Understand that head injuries can be prevented Understand the urgency involved with caring for brain injuries Describe the numerous types of head injuries VERY IMPORTANT!!!! ATC must act quickly to lessen the chance of death and permanent injury. Any head injury must be taken seriously. Better safe than sorry! Anatomy of the head Skull is composed of 28 bones Skull protects the brain A suture line is where two bones in the skull come together The only moveable bone in the skull is the mandible (lower jaw). The Brain Made up of billions of cells Weighs about 3 pounds Requires 20% of the total body oxygen Requires 15% of the blood supply Brain cells grow and develop until age 18 After 18, brain cells can be destroyed and not reproduced How important is oxygen to the brain? Depriving oxygen to the brain will cause unconsciousness and then death Pupils dilate within 60 seconds After 4-6 minutes: biological brain death occurs Large number of cells are dying Lobes of the brain Brain is divided into lobes Each lobe is named after the bony structure of the skull that it covers 4 lobes: occipital, temporal, parietal, and frontal Each lobe is responsible for specific body functions Traumatic Brain Injuries: Effects of damage to different lobes of the brain - YouTube Brain Areas and Functions Frontal lobe: voluntary muscle movements, emotion, and eye movements Parietal lobe: sensation Occipital lobe: vision Temporal lobe: hearing, speech Cerebellum: equilibrium, muscle actions, some reflexes The Brain Attaches to the spinal cord at the brain stem via a crossover Right side of the brain controls the left side of the body and vice versa Preserving brain function is of utmost importance Athlete’s quality of life and his degree of recovery depends on how a brain injury is handled Cerebrospinal fluid Bathes the brain and spinal cord in chemicals for proper functioning, helps maintain regular pressure around the brain and spinal cord, and protects the brain from impact Clear amber in color May drain from an opening in the skull, nose, or ear when a severe head injury occurs Allow this fluid to drain; stopping the drainage will increase the pressure within the skull and cause more brain damage. The Scalp Part of the skin that covers the skull Contains a large number of blood vessels, muscles, and hair Skin protects against infection Hair protects the skin from the sun and helps keep dirt and sweat away from the eyes Blood vessels are so numerous that even a small cut can bleed profusely A blow to the head can cause many blood vessels to break open and bleed under the skin-causes a lump called a hematoma The Scalp Has the ability to decrease the force of an impact to the skull due to additional padding (however small) it provides and the increased elasticity created by the tension of the connective tissue between the scalp and skull Believed that without the scalp, the skull could be fractured with as little as 40 lbs of pressure. With the scalp, it may take 425 lbs of pressure to fracture the skull Preventing Head Injuries Head injuries prevented by: helmets mouth guards rules common sense Mouth Guards The unsung hero of preventing head injuries (along with protecting your teeth) Provide spacing and shock absorption between mandible and maxilla (prevents the shock from being transmitted to the brain stem) Impact to the chin drives the mandible into the maxilla and causes the brain stem to twist slightly, which results in unconsciousness Must be fitted and in good condition to be effective Helmets Properly fitted helmets help protect the athlete’s head from direct impact Face masks protect the face Spearing-use of the head to make contact with another player Resulted in numerous neck injuries that resulted in permanent injuries or death Illegal, results in a penalty usually severe enough to get ejected from the game Skills and Rules Athletes need to be taught the proper skills and rules in order to prevent injuries Coaches should take the time to teach proper safety skills and should communicate with ATC when this will take place Coaches or ATC should also explain the signs and symptoms of head injuries to athletes What can coaches do to prevent/recognize head injuries? Head Injury Mechanisms Injuries can be caused by impact or rotations of the head Most commonly caused by impact Region most susceptible to injury is the temporal region (bone is the thinnest here) Contrecoup-injury occurs when the head is moving and receives a blow Upon impact, brain sloshes to the opposite side of the skull and stops when it impacts the side of the skull Athlete complains of a headache opposite of the impact Head Injury Mechanisms Rotations of the head after an initial impact can cause the brain stem to stop functioning normally Nerve receptors are overloaded with information to the brain Brain overload causes unconsciousness This allows for a sorting of the impulses Treating Head Injuries Potentially life-threatening head injuries: Skull fractures Concussions Intracranial hematomas Skull Fractures Occur when there is a significant force against the head Several types of fractures: Depressed-pushes a portion of the skull inside toward brain Linear-goes across skull Compound-portion of skull sticking through scalp Penetrating-object has gone through scalp, skull, and likely the brain Skull Fractures Will discolor the area behind the ear Called a battle sign **Requires immediate attention of a physician Concussion Temporary impairment of brain function caused by impact to the head or by a rotation force Sends a sudden massive number of impulses to the brain Brain becomes overwhelmed-athlete may be confused, dazed, or even lose consciousness Symptoms of Concussions Confused/dazed Nausea or vomitting Dizziness Headache Tinnitus-ringing in ears Loss of balance Amnesia-difficulty remembering things before or after impact Disorientation Concussion Grading Mild (1st degree)-no loss of consciousness and athlete symptoms/abnormalities resolve in less than 15 minutes Moderate (2nd degree)-no loss of consciousness but athlete symptoms/abnormalities last longer than 15 minutes Concussion Grading Severe (3rd degree)-any loss of consciousness Rapid eye movement Pupils may be unequal in size (pupil on side of injury is usually bigger) May be in a coma but can hear what people are saying Increase in BP Decrease in pulse rate Signs of shock Possible neck injury may have occurred Intracranial Hematoma Severe bleeding within the brain caused by a blow to the head Causes significant increase in pressure on the brain Rapid death can occur If athlete is found in a coma, chances of survival are 40% Survival depends on early examination by a physician and prompt surgical care Intracranial Hematoma Typically a hole is drilled in the skull to allow drainage of blood and attempt to repair the bleeding vessel If athlete is not in a coma, physician will put them in a coma Comatose state helps keep the athlete calm and allows the brain to heal without movement Symptoms of Intracranial Hematoma Headaches Nausea/vomiting Loss of consciousness Paralysis of extremities on opposite side of injury Battle sign Signs of a Hematoma Rise in BP Drop in pulse Pupil on same side of injury is enlarged Difficulty speaking Rapid eye movements Unconsciousness or coma Lack of coordination Difficulty using extremities side opposite of hematoma **athlete may fully recover, suffer permanent brain impairment, or die Post-concussion Syndrome Persistence of symptoms May include headache, ringing in the ears, dizziness, or confusion Should be seen by a physician Usually doesn’t last more than a week or two Second-Impact Syndrome Damage from concussions and brain injuries are cumulative in nature If athlete returns to sport before symptoms of first concussion have completed subsided and he receives another blow to the head, can quickly lose brain function and go into a coma Second-impact can disturb the brain’s blood supply and present signs of a minor concussion followed by a semicomatose state Athletes must be symptom free and clearance from a doctor before returning to play SESD Gradual Return to Play Athlete must be symptom free for 24 hours prior to taking the ImPACT If athlete passes ImPACT, begin 5-day gradual return to play Day 1: 20 minute walk Day 2: 20 minute jog Day 3: Sport specific activity (no contact) Day 4: Controlled contact Day 5: Full participation