The Head and Face

Chapter 22 part 1

Preventing Injuries to the Head  Wearing proper protective equipment  Instruct proper techniques of wearing the head and face equipment  Instruct proper techniques of usage of head and face equipment

Anatomy of the Head 

Skull (comprised of 22 bones)

Anatomy of the Head

Scalp

– Skin – Subcutaneous connective tissue – Aponeurosis – Loose connective tissue – periosteum

Anatomy of the Head 

Brain

– Meninges • Dura Mater • Arachnoid Mater • Pia Mater – cerebrospinal fluid

Anatomy of the Head 

Dura Mater

• dense, fibrous, inelastic sheath next to the periosteum • functions to protect the brain from injury if skull is fractured, (limits movement of brain) • Contains CSF

Anatomy of the Head 

Arachnoid Mater

• • • • • • • Delicate, slippery, elastic, cobweb like Applied to dura but not attached Separated from pia by CSF Contains cerebral veins Provides little support Shearing can occur with sudden movement Blood will spread freely if cerebral arteries are ruptured (will see blood in CSF – not good)

Anatomy of the Head 

Subarachnoid space

• • The space between the arachnoid and pia mater Contains CSF 

Pia mater

• • Delicate, thin membrane Follows brain and holds small blood vessels close to surface • Highly vascularized

Assessing Head Injuries Conscious Athlete

History

 Determine level of consciousness  ABC’s  How did this happen?

 Is there pain in the neck?

 Where are you?

 Symptoms • • • • • Headache Dizziness Vomiting Ringing in ears Changes in personality • Speech changes

Assessing Head Injuries Conscious Athlete  Observation – Fluid from ears, nose, eyes, mouth – Lacerations, bruises, swelling, bleeding – Alertness – signs

Assessing Head Injuries Conscious Athlete  Palpation – Gentle touch to determine areas of sensitivity or deformity

Assessing Head Injuries Conscious Athlete  Special Test • Eye function – Tracking, vision near and far • Balance Test – Drifting, Rhomberg’s sign • Coordination Test – Finger to nose, combination lock • Cognitive Test – Serial 7’s, months of year backwards

Assessing Head Injuries Unconscious Athlete  Follow guidelines to assess unconscious athlete  Determine level of consciousness and activate EAP  Determine treatment – – CPR AR – C-spine collar and spine board

Recognition and Management of Specific Head Injuries

Skull Fracture 

Etiology

– Blunt trauma 

Symptoms and Signs

– – – – Severe headache Nausea Bleeding from ears, nose, (raccoon eyes) CSF, (straw coloured) from ears or nose 

Management

– EAP, immediate hospitalization to avoid complications from intracranial bleeding

Cerebral Concussion

“A clinical syndrome characterized by immediate and transient posttraumatic impairment of neural functions,…” (Arnheim)

Cerebral Concussion 

Etiology

– Direct blow, (contrecoup) – Shaking of the brain 

Symptoms and Signs

– Headache, – – – – – – tinnitus, nausea, irritability, confusion, disorientation, dizziness, – – – – – – – loss of consciousness Posttraumatic amnesia Retrograde amnesia Difficulty concentrating Blurred vision Photosensitivity Sleep disturbance

Cerebral Concussion 

Management

 Returning to sport after head trauma – – normal neurological function normal in all vasomotor functions – – free of headaches free of seizure - normal electroencephalogram – free of light-headedness when suddenly changing body positions

Cerebral Concussion  Classification of Concussions – Colorado – American Academy – McGill

Post Concussion Syndrome



Etiology

– may appear with mild or sever concussion, poorly understood 

Symptoms and Signs

– – – – – persistent headache, impaired memory, lack of concentration, anxiety, Irritability, – – – – Giddiness, fatigue, depression, visual disturbances Symptoms may begin immediately or several days after trauma and may last weeks or months

.

Post Concussion Syndrome

, 

Management

–

not clear, no return to activity until symptom free, follow guidelines

Second Impact Syndrome



Etiology

– rapid swelling and herniation to brain, when second head injury occurs before previous injury heals. The impact may be minor and may not involve a blow to head.



Symptoms and Signs

– often no loss of consciousness.

– – mortality rate high. condition worsens rapidly.



Management

– – Must see Dr.

May require EAP

Epidural Hematoma 

Etiology

– – – A severe blow to the head, skull fracture or sudden brain shift causes bleeding between the dura and periosteum a ruptured artery in the dural membrane 

Symptoms and Signs

– Typically brief concussion, – Usually but not always loss of consciousness, followed by a lucid interval, usually lasts hours (24 --48), rarely days.

– – Deterioration of vital signs This is a life threatening injury 

Management

– EAP and monitor vital signs.

– Need to have pressure surgically removed as soon a possible.

Subdural Hematoma 

Etiology

– – Contrecoup or rotational acceleration/deceleration head trauma veins between brain and dura mater are torn – slower – occurs more frequently than epidural haematoma 

Symptoms and Signs

– may have loss of consciousness, become lucid and then deteriorate.

– headache, nausea, vomiting, irritability, diplopia, paralysis of contra lateral extremities, coma, rapid progression 

Management

– – This is life threatening and requires immediate medical attention Activate EAP

Recognition and Management of Specific Head Injuries  Cerebral Contusion –

Etiology

• • Intracranial bleeding Impact from head striking immovable object –

Symptoms and Signs

• Loss of consciousness • Headaches, dizziness, nausea –

Management

• • Varies according to injury May require hospitalization

Recognition and Management of Specific Head Injuries 

Scalp Injuries

– laceration, abrasion, contusion, hematoma –

Etiology

–

Symptoms and Signs

–

Management