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  • 1. Head Injuries
  • 2. Managing the Unconscious Athlete
    • Why is this so scary?
    • Can not collect symptoms so must rely on signs
    • Always treat as though have cervical spine injury
    • Always stay calm
  • 3. Mechanisms for Rendering an Athlete Unconscious
    • Blow to head
    • Diabetic Coma
    • Hypoglycemia
    • Electric Shock
    • Heat Illness
    • Drowning
    • Psychogenic Shock
    • Syncope
    • Illness
    • Substance Abuse
    • Epileptic Siezures
    • Rhabdomyolysis
    • Others?
  • 4. Remember what you have learned thus far!!
    • Check
    • Call
    • Care
  • 5. Conduct life-threatening measures
    • Treat severe bleeding
    • CPR
    • AED
  • 6. History
    • Know/get past medical history
    • Mechanism
      • If you missed, what should you do?
  • 7. Inspection
    • Otorrhea
    • Rhinorrhea
    • Battle’s Sign
    • Raccoon Eyes
    • Body Position
      • Decorticate rigidity
        • Arms flexed, legs extended
      • Decerebrate rigidity
        • Arms & legs extended
    • Swelling, Deformity, Bleeding, Discoloration
  • 8. Determine Quality of Life
    • Pulse
    • Respirations
    • Pupils
    • Blood Pressure
    • Record with time
  • 9. Establish State of Consciousness
    • Glasgow Coma Scale
      • Coma Definition
      • Assesses depth and duration of coma
      • Grades a wide variety of conditions
  • 10. Glasgow Coma Scale Eye Opening Response Spontaneous – opening with blinking at baseline 4 points To verbal stimuli, command, speech 3 points To pain only (not applied to face) 2 points No response 1 point Verbal Response Oriented to place, time, etc 5 points Confused conversation, but able to answer questions 4 points Inappropriate Words 3 points Incomprehensible speech 2 points No response 1 point Motor Response Obeys commands for movement 6 points Purposeful movement to painful stimulus 5 points Withdraws in response to pain 4 points Flexion in response to pain (decorticate posturing) 3 points Extension in response to pain 2 points No response 1 point
  • 11. Head Injury Classification Scores
    • Sever Head Injury
    • Moderate Head Injury
    • Mild Head Injury
  • 12. Palpation
    • Head to toe evaluation
    • General information seeking
    • Head structures
    • Cervical structures
    • Upper Extremity
    • Arms
    • Chest
    • Abdomen
    • Lower Extremity
  • 13. Oh no, What do I do?
    • STAY CALM
    • “ Know that you are in control of the controllable but YOU CANNOT DICTATE THE OUTCOME”
    • Be the leader
    • Practice, Practice and more PRACTICE
      • SOMEONE’S LIFE MAY BE IN YOUR HANDS
  • 14. Concussions
  • 15. Definition
    • Clinical syndrome characterized by immediate and transient impairment of neurological function secondary to mechanical forces
    • Statistic on Brain Injury
      • 750,00 total injuries
        • 85,000 brain injuries
      • NFL= 3.5 brain injuries/game
      • 10% college and 20% HS football players suffer brain injuries
      • 5% soccer players suffer brain injuries
  • 16. Mechanism
    • Coup Injury
    • Contrecoup Injury
    • Types of forces causing brain injury
  • 17. Acute Concussion Sign and Symptoms
    • Headache
    • Consciousness Levels
    • Memory Impairment
      • Retrograde amnesia
      • Anterograde amnesia
    • Cognitive Function Deficits
    • Behavioral Changes
    • Balance and Coordination
    • Tinnitis
    • Pupil Size
      • Aniscoria
    • Nystagmus
    • Vision Acuity
    • Nausea
    • Pulse
    • Blood Pressure
    • Respirations
  • 18. Injury Classification
    • Epidemiology
    • American Academy of Neurology Grading Scale
      • Grade 1
      • Grade 2
      • Grade 3
      • Advantage/Disadvantages
    • Cantu Evidence Based Grading Scale
      • Grade 1
      • Grade 2
      • Grade 3
      • Advantage/ Disadvantages
  • 19. NATA Position Statement
    • Avoid grading scales
    • Focus on Recovery
    • Is the athlete symptomatic ofor asymptomatic
    • Once asymptomatic focus on progresssion
  • 20. Post-concussion Symtpoms
    • Photophobia
    • Sensitivity
    • Seeing stars or flashing lights
    • Poor concentration
    • Irritability
    • Depression
    • Anxiety
    • Fatigue
    • Headache
    • Sleep disturbance
  • 21. Post-concusion Assessment
    • Mental Testing Assessment
    • Postural-stability Tests
    • Neuropsychological Tests
  • 22. Post-concussion Assessment
    • Mental Status Testing
      • Standardized Assessment of Concussion Test
        • Orientation
        • Immediate memory
        • Concentration
        • Delayed recall
        • Also measures
          • Strength
          • Sensation
          • Coordination
          • Neurological exam
          • LOC and anmnesia also recorded
        • Max score
        • Low scores?
        • Need good baseline data
  • 23. Post-concussion Assessment
    • Postural-stability Assessment
      • Romberg or Stork Tests
      • Balance Error Scoring System (BESS)
        • 3 stance positions
        • 2 different surfaces
        • Test Position
        • Count errors
          • What counts as an error
        • There is a practice effect from multiple trials
  • 24. Post-concussion Assessment
    • Neuropsychological Testing
      • Most require licensed and board certified psychologist
      • Tests include
        • Attention
        • Concentration
        • Memory function
  • 25. Return to Play Decisions
    • Some guideline require 7 day of symptom free
    • Begins with progression
    • SAC
      • Both rest and exertional assessment
    • All tests baseline or better
    • NATA Position Statement
      • Minimum 7 days after asymptomatic
  • 26. Guidelines for RTP after several Concussions Prentice, Principles of AT, 13 th ed
  • 27. When do you refer to physician?
    • Any LOC
    • Decr. LOC
    • Amnesia >15 min
    • *Decr. neurological function
    • *Decr. or irregularity of respirations
    • * Decr. Or irregularity of pulse
    • Increase in BP
    • *Mental status changes
    • *Seizures
    • *Unequal, unresponsive or dilated pupils
    • Cranial nerve deficits
    • *Injuries associated with spine, skull fractures
    • Subsequent to Initial Eval
      • Motor deficits
      • Sensory deficits
      • Balance deficits
      • Cranial nerve deficits
      • Post-concussion symptoms that worsen
    * Indicates that patient be transferred immediately to nearest emergency facility
  • 28. Secondary Impact Syndrome
    • What is it?
    • Signs
    • Treatment
  • 29. Epidermal Hematoma
    • Bleeding between scalp and skull
    • Little concern unless have S/S of head spine injuriy
  • 30. Epidural Hematoma
    • Etiology
      • Associated with skull fractures
      • Tear in meningeal arteries
    • S/S
    • Management
      • Medical Emergency
  • 31. Subdural Hematoma
    • Etiology
      • Acceleration/deceleration force
      • 3 kinds
    • S/S
    • Management
      • Referral
  • 32. Skull Fracture
    • Mechanism
      • Blunt trauma
      • Types of fractures
    • S/S
    • Management
      • ABC’s
      • CSF leakage
  • 33. Putting it Together
    • History
      • Ask people
      • Establish level of consciousness
      • Headache
      • Senses
      • Memory
    • Inspection
      • LOC
      • ABC’s
      • Head Position
      • Skull
      • Mastoid Process
      • Eyes, ears, nose
      • Body Position
      • Movements
      • Behavior
      • Facial expressions
    • Palpation
      • Head/Scalp
      • Cervical spine
      • Soft Tissue
      • Vital signs
    • Functional Tests
      • Cognitive Function (Subjective)
      • Cognitive Function (Objective)
        • SAC
      • Balance and Coordination
    • Neurological Tests
      • Dermatomes
      • Myotomes
    • Continue Monitoring
      • Every 5 minutes