Transcript Concussion Jennifer L. Doherty, MS, LAT, ATC Management of Medical Emergencies Concussion • Head/Brain injury • Temporary impairment of brain function • MOI: Direct or Indirect blow to.

Concussion
Jennifer L. Doherty, MS, LAT, ATC
Management of Medical Emergencies
Concussion
• Head/Brain injury
• Temporary
impairment of brain
function
• MOI: Direct or Indirect
blow to the head
Concussion
• Serious head injuries almost always
represent a life-threatening situation
• Must get athlete to the hospital
immediately
– Within 30 minutes
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
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
Signs and Symptoms cont…
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Nausea or vomiting
Persistent headache
Loss of balance
Ecchymosis
– Especially around the
eyes or behind the
ears
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
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
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
Secondary Assessment
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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
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
Secondary Assessment cont…
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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
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)
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
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
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
General Concussion Classification
Grade III Concussion
• Normal consciousness
• Confusion
• Post-traumatic amnesia
• Retrograde amnesia
– Inability to recall events that occurred before
the injury
General Concussion Classification
Grade III Concussion cont…
• Unsteadiness/Dizziness
• Tinnitus
• Headache
• Confusion
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
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
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
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
Glasgow Coma Scale
Type
Stimulus
Type of Response
Points
Eyes
Open
Spontaneously
To verbal command
To pain
No response
4
3
2
1
Best Motor
Response
To verbal command
To painful stimulus
Obeys
Localized pain
Flexion-withdrawal
Flexion-abnormal
Extension
No response
6
5
4
3
2
1
Oriented and converses
Disoriented and converses
Inappropriate words
Incomprehensible sounds
No response
5
4
3
2
1
Best Verbal
Response
Lowest score = 3, Highest score = 15
General Concussion Classification
Grade VI Concussion
• Death
Secondary Conditions Associated
with Concussions
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Intracranial Hemorrhage
Skull Fracture
Epidural Hemorrhage
Subdural Hemorrhage
Intracerebral Hemorrhage
Cerebral Hyperemia
Cerebral Edema
Seizures
Migraine Headaches
Intracranial Hemorrhage
• Intracranial bleeding
• Venous bleeding
– Slow, insidious onset
• Arterial bleeding
– S/S apparent within a
few hours
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
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
Epidural Hemorrhage
• Requires surgery to
relieve the pressure
created by the
hemotoma
• Death or permanent
disability may result
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
Subdural Hemmorhage
• Commonly occurs
following a
contrecoup injury
• May or may not
require surgery
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
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
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
Criteria to Return to Play
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Normal neurological function
Normal vasomotor functions
Normal balance
Free of headaches
Free of lightheadedness
Free of dizziness
Free of seizures
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
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
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