Head Injuries
Managing the Unconscious Athlete <ul><li>Why is this so scary? </li></ul><ul><li>Can not collect symptoms so must rely on ...
Mechanisms for Rendering an Athlete Unconscious <ul><li>Blow to head </li></ul><ul><li>Diabetic Coma </li></ul><ul><li>Hyp...
Remember what you have learned thus far!! <ul><li>Check  </li></ul><ul><li>Call </li></ul><ul><li>Care </li></ul>
Conduct life-threatening measures <ul><li>Treat severe bleeding </li></ul><ul><li>CPR </li></ul><ul><li>AED </li></ul>
History <ul><li>Know/get past medical history </li></ul><ul><li>Mechanism </li></ul><ul><ul><li>If you missed, what should...
Inspection <ul><li>Otorrhea </li></ul><ul><li>Rhinorrhea </li></ul><ul><li>Battle’s Sign </li></ul><ul><li>Raccoon Eyes </...
Determine Quality of Life <ul><li>Pulse </li></ul><ul><li>Respirations </li></ul><ul><li>Pupils </li></ul><ul><li>Blood Pr...
Establish State of Consciousness <ul><li>Glasgow Coma Scale </li></ul><ul><ul><li>Coma Definition </li></ul></ul><ul><ul><...
Glasgow Coma Scale Eye Opening Response Spontaneous – opening with blinking at baseline 4 points To verbal stimuli, comman...
Head Injury Classification Scores <ul><li>Sever Head Injury </li></ul><ul><li>Moderate Head Injury </li></ul><ul><li>Mild ...
Palpation <ul><li>Head to toe evaluation </li></ul><ul><li>General information seeking </li></ul><ul><li>Head structures <...
Oh no, What do I do? <ul><li>STAY CALM </li></ul><ul><li>“ Know that you are in control of the controllable but YOU CANNOT...
Concussions
Definition <ul><li>Clinical syndrome characterized by immediate and transient impairment  of neurological function seconda...
Mechanism <ul><li>Coup Injury </li></ul><ul><li>Contrecoup Injury </li></ul><ul><li>Types of forces causing brain injury <...
Acute Concussion Sign and Symptoms <ul><li>Headache </li></ul><ul><li>Consciousness Levels </li></ul><ul><li>Memory Impair...
Injury Classification <ul><li>Epidemiology </li></ul><ul><li>American Academy of Neurology Grading Scale </li></ul><ul><ul...
NATA Position Statement <ul><li>Avoid grading scales </li></ul><ul><li>Focus on Recovery </li></ul><ul><li>Is the athlete ...
Post-concussion Symtpoms <ul><li>Photophobia </li></ul><ul><li>Sensitivity </li></ul><ul><li>Seeing stars or flashing ligh...
Post-concusion Assessment <ul><li>Mental Testing Assessment </li></ul><ul><li>Postural-stability Tests </li></ul><ul><li>N...
Post-concussion Assessment <ul><li>Mental Status Testing </li></ul><ul><ul><li>Standardized Assessment of Concussion Test ...
Post-concussion Assessment <ul><li>Postural-stability Assessment </li></ul><ul><ul><li>Romberg or Stork Tests </li></ul></...
Post-concussion Assessment <ul><li>Neuropsychological Testing </li></ul><ul><ul><li>Most require licensed and board certif...
Return to Play Decisions <ul><li>Some guideline require 7 day of symptom free </li></ul><ul><li>Begins with progression </...
Guidelines for RTP after several Concussions Prentice, Principles of AT, 13 th  ed
When do you refer to physician? <ul><li>Any LOC </li></ul><ul><li>Decr. LOC </li></ul><ul><li>Amnesia >15 min </li></ul><u...
Secondary Impact Syndrome <ul><li>What is it?  </li></ul><ul><li>Signs </li></ul><ul><li>Treatment </li></ul>
Epidermal Hematoma <ul><li>Bleeding between scalp and skull </li></ul><ul><li>Little concern unless have S/S of head spine...
Epidural Hematoma <ul><li>Etiology </li></ul><ul><ul><li>Associated with skull fractures </li></ul></ul><ul><ul><li>Tear i...
Subdural Hematoma <ul><li>Etiology </li></ul><ul><ul><li>Acceleration/deceleration force </li></ul></ul><ul><ul><li>3 kind...
Skull Fracture <ul><li>Mechanism </li></ul><ul><ul><li>Blunt trauma </li></ul></ul><ul><ul><li>Types of fractures </li></u...
Putting it Together <ul><li>History </li></ul><ul><ul><li>Ask people </li></ul></ul><ul><ul><li>Establish level of conscio...
Upcoming SlideShare
Loading in …5
×

Power Point Presentation

705 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
705
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
20
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Power Point Presentation

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

×