1 / 49

Concussion

Concussion . By Brian Gober & Anedra Smith Evaluation of Athletic Injuries I AH 322 09/03/03. Statistics. 10% of head injury patients die before reaching the hospital 5% head injuries have spinal damage 25% spinal injuries have a mild head injury

xylia
Download Presentation

Concussion

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Concussion By Brian Gober & Anedra Smith Evaluation of Athletic Injuries I AH 322 09/03/03

  2. Statistics • 10% of head injury patients die before reaching the hospital • 5% head injuries have spinal damage • 25% spinal injuries have a mild head injury •  sports and recreation make up 10% of cases

  3. Concussion • Concussion: An injury in which the brain becomes impaired or loses its ability to perform its duties properly.

  4. Concussion cont. • Traditionally characterized by immediate and transient posttraumatic impairment of neural functions. (Prentice 885) • Typically caused by mild-to-moderate impact to the skull and/or movement of the brain within the cranial vault (Sanders 433)

  5. Neural Functions Involved • Consciousness • Vision • equilibrium

  6. Signs and Symptoms • Memory or Orientation Problems: • Unaware of time, date, place • Unaware of period, opposition, score of game • General confusion • Loss Of Consciousness

  7. Symptoms • Headache • Dizziness • Feeling "dinged" or stunned • "Having my bell rung" • Feeling dazed • Seeing stars or flashing lights

  8. Symptoms cont. • Ringing in the ears • Sleepiness • Loss of field of vision • Double vision • Feeling "slow" • Nausea

  9. Signs • Poor coordination or balance • Vacant stare/glassy eyed • Vomiting • Slurred speech • Slow to answer questions or follow directions • Easily distracted, poor concentration

  10. Signs Cont. • Displaying unusual or inappropriate emotions (e.g. laughing, crying) • Personality changes • Inappropriate playing behavior (e.g. skating or running the wrong direction) Significantly decreased playing ability from earlier in the game/competition

  11. Initial Assessment • Level of Consciousness (Alert, Verbal Stimuli, Pain Stimuli, Unresponsive) • ABCs • Initial C-spine precautions due to possible neck injury from MOI • Pupil Response

  12. Pupil Size Equal Pupils

  13. Pupil Size Dilated Pupil

  14. Pupil Size Constricted (Pinpoint) Pupils

  15. Pupil Size Unequal Pupils

  16. Assessment • Consciousness • Orientation • Posttraumatic Amnesia • Retrograde Amnesia • Other S/S: Headache, dizziness, blurred vision, and nausea

  17. Neuropsychological Deficits • Disturbances of new learning and memory,planning, and the ability to switch mental “set” • Reduced attention and speed of information processing, including test strategies such as the digit symbol subtest of the Wechsler Abbreviated Scale of Intelligence

  18. Assessment ClassificationSystems • Robert C. Cantu, MD (1988) • Colorado Medical Society System • American Academy of Neurology Guidelines

  19. Cantu Grading System • Grade 1 (mild): No loss of consciousness; posttraumatic amnesia less than 30 min • Grade 2 (moderate): Loss of consciousness less than 5 min or posttraumatic amnesia greater than 30 min • Grade 3 (severe): Loss of consciousness greater than 5 min or posttraumatic amnesia greater than 24 hr

  20. Colorado Medical Society System • Grade 1: Confusion without amnesia, no loss of consciousness • Grade 2: Confusion with amnesia, no loss of consciousness • Grade 3: Loss of consciousness

  21. American Academy of Neurology Guidelines • Grade 1: Transient confusion, no loss of consciousness, concussion symptoms less than 15 minutes • Grade 2: Transient confusion, no loss of consciousness, concussion symptoms greater than 15 minutes • Grade 3:Any loss of consciousness (brief or prolonged)

  22. Concussion Classification It is imperative to remember: Any Loss of Consciousness greater than 30 minutes should point to a more serious brain injury than concussion ( e.g. Subdural Hematoma, Epidural Hematome, Basilar Skull Fracture, etc.)

  23. Classification of LOC Glasgow Coma Scale (GCS) • The GCS is scored between 3 and 15, 3 being the worst, and 15 the best. It is composed of three parameters : Best Eye Response, Best Verbal Response, Best Motor Response

  24. Eye Response (GCS) • No eye opening. • Eye opening to pain. • Eye opening to verbal command. • Eyes open spontaneously

  25. Verbal Response • No verbal response • Incomprehensible sounds. • Inappropriate words. • Confused • Orientated

  26. Motor Response (GCS) • No motor response. • Extension to pain. • Flexion to pain. • Withdrawal from pain. • Localizing pain. • Obeys Commands.

  27. Classification with Negative LOC Start Progression To I. Confusion Normal consciousness without amnesia II. Confusion Normal consciousness with posttraumatic amnesia III. Confusion Normal consciousness with posttraumatic amnesia plus retrograde amnesia IV. Coma (paralytic) Level III: Normal consciousness with posttraumatic amnesia plus retrograde amnesia V. Coma Vegetation state or death VI. Death

  28. Sideline Evaluation Mental Status Testing • Orientation: Time, place, person, and situation • Concentration: Digits Backwards, Months of year in reverse order • Memory: Names of teams, recall 3 words or objects, recent events, details of contest (score)

  29. Sideline Evaluation Exertional Provacative Tests • 40 yard sprint • 5 push-ups • 5 sit-ups • 5 knee-bends

  30. Sideline Evaluation Neurological Tests • Strength • Coordination and agility • Sensation

  31. Grade 1 Multiple Grade 1 Grade 2 Multiple Grade 2 15 min or less 1 week 1 week 2 weeks Return to Play Time Asymptomatic Grade of Concussion

  32. Grade 3: Brief Loss of Conciousness Grade 3: Prolonged Loss of Consciousness Multiple Grade 3 1 week 2 weeks 1 month or longer, physician decision Return to Play

  33. Racoon Eyes (Periorbital Ecchymosis)

  34. Battle’s Sign (Mastoid Hematoma)

  35. Second Impact Syndrome • This occurs when an athlete, who has already sustained a head injury, sustains a second  head injury before symptoms have cleared from the first injury.  Many times this occurs because the athlete has returned to competition and play before his or her first injury symptoms resolve.  Coaches and athletes do not realize that days or weeks may be needed before concussion symptoms resolve.

  36. Second Impact Syndrome • A second blow to the head, even if it is a minor one, can result in a loss of auto regulation of the brain's blood supply.  Loss of autoregulation leads to brain swelling.  This results in increased intracranial pressure and leads to herniation of the brain. 

  37. Second Impact Syndrome • The average time from second impact to brainstem failure is quite rapid, taking two to five minutes.  Once herniation and brainstem compromise occur, ocular movement and respiratory failure are likely to result.

  38. Second Impact SyndromeSigns/Symptoms • Within seconds or minutes of the second impact, the athlete who is conscious, yet stunned may:  -collapse to the ground  -semi comatose with rapidly dilating pupils  -loss of eye movement  -evidence of respiratory failure

  39. Conclusion • In order for these test to effectively work, it is best to establish a baseline during an athletes PPE. • Tests may be modified for use in various field elements, however they are intended for evaluation over a period of days. • Used effectively, they can help decide an athletes return to participation time frame.

  40. Conclusion • It is extremely important that when initially assessing an athlete for a head injury that you rule out sign/symptoms for more severe Traumatic Brain Injuries (TBI) • Serious Signs/Symptoms: Periorbital Echymosis, “Battle” signs, Bleeding from nose, ears, mouth, Clear Fluid (CSF) from openings, deformity, Unequal Pupils

  41. Questions?? • What is a concussion? • A. A bleed within the portion of the brain just below the dura mater • B. An injury in which the brain becomes impaired or loses its ability to perform its duties properly. • C. An occlusion on the cerebral arteries. • D. None of the Above

  42. Questions?? • Signs of a Concussion include? • A. Dizziness • B. Nausea/Vomiting • C. Confusion • D. Paralysis • E. A, C, & D • F. A, B, & C • G. A, B, C, & D

  43. Questions?? • Which of the following is a form of Neurocognitive Assessments? • A. Pupillary reflex • B. Sensory Organization Test • C. BESS • D. Stroop Color Word Test • E. All of the above

  44. Questions?? • Which are errors commonly seen within the BESS method of Assessment? • A. Step, stumble, or fall • B. Moving hip into more than 30 degrees of flexion or abduction • C. Lifting forefoot or heel • D. All of the Above • E. None of the Above

  45. Questions?? • The best grading system for use with the assessment of a concussion is: • A. The R.T. Floyd Assessment Scale • B. The Cantu Method • C. The Colorado Medical Society Scale • D. None of the Above

  46. References • McCrea, M. “Standardized Mental Status Testing on the Sideline after Sport-Related Concussion.” Journal of Athletic Training. 36 (3): 274-279. 2001. www.journalofathletictraining.org • Guskiewicz, K., Ross, E., &Marshall, S.: “Postural Stability and Neuropsychological Deficits After Concussion in Collegiate Athletes.” Journal of Athletic Training. 36(3): 263-273, 2001: www.journalofathletictraining.org.

  47. References • Roos, R. “Guidelines for Managing Concussion in Sports: A Persistent Headache” The Physician and Sportsmedicine. Vol. 24. No. 10. October 1996. 2/3/03. www.physsportsmed.com • McCrory, P., Johnston, K. “Acute Clinical Symptoms of Concussion.” The Physician and Sportsmedicine. Vol. 30. No. 8. August 2002. 2/3/03. www.physsportsmed.com

  48. References • Kelly, J. ”Loss of Consciousness: Pathophysiology and Implications in Grading and Safe Return to Play.” Journal of Athletic Training. 36 (3): 249-252. 2001. www.journalofathletictraining.org •  Prentice, William. Arnheim’s Principles of Athletic Training. McGraw-Hill,New York. 2003. • Sanders, Mick. Mosby’s Paramedic Textbook. Mosby, St. Louis. 1994.

More Related