Head InjuriesHead Injuries

Care & Prevention of Athletic Care & Prevention of Athletic InjuriesInjuries

Ms. Herrera ATC/LMs. Herrera ATC/L

AnatomyAnatomy

Skull is made of 22 bonesSkull is made of 22 bones Joined together by “sutures” (immovable joints)Joined together by “sutures” (immovable joints) Temporal bone is the thinnest aspect.Temporal bone is the thinnest aspect.

Anatomy Cont’dAnatomy Cont’d

CNS is comprised of CNS is comprised of the brain and spinal the brain and spinal cord.cord.

Functions of the…Functions of the… CerebrumCerebrum CerebellumCerebellum PonsPons Medulla OblongataMedulla Oblongata

Anatomy Con’tdAnatomy Con’td

MeningesMeninges 3 layers3 layers

Dura Mater, Arachnoid, Dura Mater, Arachnoid, and Pia Materand Pia Mater

Subdural space divides Subdural space divides the dura and arachnoid the dura and arachnoid spacespace

CSF function?CSF function? Suspends the brainSuspends the brain CushionsCushions Lessons forces Lessons forces

General InformationGeneral Information

Head injuries occur in…Head injuries occur in… Contact and collision sportsContact and collision sports

Examples?Examples?

MOIMOI Direct blow to the headDirect blow to the head Impact causing the head to snap in different Impact causing the head to snap in different

directionsdirections

General Signs & General Signs & SymptomsSymptoms

Brain injury may result in…Brain injury may result in… LOCLOC

Track time of LOCTrack time of LOC DisorientationDisorientation AmnesiaAmnesia Motor coordinationMotor coordination Balance deficitsBalance deficits Cognitive deficitsCognitive deficits

If ath has LOCIf ath has LOC Must consider C-spine injuryMust consider C-spine injury

HistoryHistory

Can you remember the score or who we played Can you remember the score or who we played last week? (retrograde amnesia)last week? (retrograde amnesia)

Can you remember walking off the field? Can you remember walking off the field? (antegrade amnesia)(antegrade amnesia)

Does your head hurt?Does your head hurt? Do you feel nauseous? Do you feel nauseous? Do you have pain in your neck?Do you have pain in your neck? Can you move your arms and legs?Can you move your arms and legs? Do you remember what happened?Do you remember what happened?

ObservationObservation

Does the athlete appear disoriented?Does the athlete appear disoriented? Does the athlete have a blank stare?Does the athlete have a blank stare? Does the athlete have incoherent speech?Does the athlete have incoherent speech? Does the athlete respond to questions with delay?Does the athlete respond to questions with delay? Are they walking with imbalance?Are they walking with imbalance? Are they unable to focus?Are they unable to focus? How are they acting emotionally?How are they acting emotionally? Is the athlete’s scalp swollen or bleeding?Is the athlete’s scalp swollen or bleeding? Does the athlete have CSF coming out of their ear?Does the athlete have CSF coming out of their ear?

PalpationPalpation

ATC should palpate the following for ATC should palpate the following for obvious deformity…obvious deformity… NeckNeck Skull Skull

Special TestsSpecial Tests Neurological ExamNeurological Exam Eye functionEye function

PERRLAPERRLA Nystagmus (demonstrate)Nystagmus (demonstrate)

Balance TestsBalance Tests Romberg Romberg BESSBESS Coordination Tests Coordination Tests

Cognitive TestsCognitive Tests Remember these 5 wordsRemember these 5 words Say the months backwardsSay the months backwards

Cranial NervesCranial Nerves

Review handoutReview handout DemonstrateDemonstrate

Skull FXSkull FX

MOI: Direct blow to the head.MOI: Direct blow to the head. Examples…Examples…

Signs & Symptoms (S&S)Signs & Symptoms (S&S) Severe headacheSevere headache NauseaNausea Indentation in skullIndentation in skull Blood in ear or noseBlood in ear or nose ““Battle’s sign”Battle’s sign” ““Racoon eyes”Racoon eyes” CSF “Halo sign”CSF “Halo sign”

ManagementManagement Activate EMSActivate EMS Refer to neurosurgeon ASAPRefer to neurosurgeon ASAP Why???Why???

Cerebral ConcussionsCerebral Concussions

Definition: “Immediate and transient Definition: “Immediate and transient impairment of brain function affecting impairment of brain function affecting equilibrium and disrupting equilibrium and disrupting consciousness.”consciousness.”

ConcussionsConcussions

MOI:MOI: Direct blowDirect blow COUP injury: stationary COUP injury: stationary

skull hit at a high velocity. skull hit at a high velocity. Injury on same side.Injury on same side.

Counter-coup: Skull Counter-coup: Skull moving at high velocity, moving at high velocity, stops suddenly, and stops suddenly, and strikes a surface causing strikes a surface causing damage to the opposing damage to the opposing side of impact.side of impact.

Acceleration/deceleration Acceleration/deceleration forces causing the brain to forces causing the brain to shake.shake.

Concussions S&SConcussions S&S

Postraumatic AmnesiaPostraumatic Amnesia Antegrade vs retrogradeAntegrade vs retrograde

Loss of balanceLoss of balance Behavior (not themselves)Behavior (not themselves) Loss of CN functionLoss of CN function Diminished neurological functionDiminished neurological function ConfusedConfused Vacant stareVacant stare Lack of focusLack of focus Delayed ResponsesDelayed Responses LOCLOC Emotions out of proportionEmotions out of proportion Slurred speechSlurred speech

ManagementManagement

LOC, suspect C-SpineLOC, suspect C-Spine Spine board and transport to ER via EMSSpine board and transport to ER via EMS CT ScanCT Scan

If no LOCIf no LOC Evaluate on sidelineEvaluate on sideline Track postconcussive signs and symptomsTrack postconcussive signs and symptoms MonitorMonitor

Not released until no s&s are presentNot released until no s&s are present Different scalesDifferent scales When to “grade” a concussion?When to “grade” a concussion?

Second-Impact SyndromeSecond-Impact Syndrome

Occurs when an ath sustains a 2Occurs when an ath sustains a 2NDND blow to the blow to the head, while still recovering from a previous head, while still recovering from a previous concussion.concussion.

Second blow can be minimal.Second blow can be minimal. Causes swelling in the brainCauses swelling in the brain

↑ ↑ intracranial pressureintracranial pressure Initially, ath appears normalInitially, ath appears normal

Moments later….Moments later…. Mortality rate of 50%Mortality rate of 50% Management?Management?

Cerebral ContusionCerebral Contusion

MOI: Impact with a MOI: Impact with a stationary objectstationary object

Causes bleeding in the Causes bleeding in the brain.brain.

S&S:S&S: LOCLOC HeadachesHeadaches DizzynessDizzyness NauseaNausea

Management: Refer to Management: Refer to ERER CT Scan or MRICT Scan or MRI

Epidural HematomaEpidural Hematoma

Hematoma between the skull and Hematoma between the skull and dura mater.dura mater.

S&S S&S Severe head painSevere head pain DizzinessDizziness Lucid intervalLucid interval NauseaNausea Dilation of 1 pupilDilation of 1 pupil SleepinessSleepiness

Management: Refer to ERManagement: Refer to ER CT scanCT scan Delayed medical attention can Delayed medical attention can

result in death or permanent result in death or permanent disabilitydisability

May be confused for mild May be confused for mild concussion.concussion.

Subdural HematomaSubdural Hematoma

More common than More common than epidural hematomasepidural hematomas

Most common cause of Most common cause of death in athletesdeath in athletes

MOI: MOI: deceleration/acceleration deceleration/acceleration forcesforces

S&S: same as epiduralS&S: same as epidural Management:Management:

Activate EMSActivate EMS Emergency!Emergency!

Scalp InjuriesScalp Injuries

MOI: Blunt trauma causes lacerationMOI: Blunt trauma causes laceration Could cause brain injuryCould cause brain injury

S&S:S&S: Profuse bleedingProfuse bleeding

Makes it difficult to?Makes it difficult to?

PainPain

Management: Refer to ERManagement: Refer to ER Requires stitchesRequires stitches CT scan to r/o brain injuryCT scan to r/o brain injury