The Head and Face

1
The Head and Face

• Chapter 22 part 1

2
Preventing Injuries to the Head

• Wearing proper protective equipment
• Instruct proper techniques of wearing the head
  and face equipment
• Instruct proper techniques of usage of head and
  face equipment

3
Anatomy of the Head

• Skull (comprised of 22 bones)

4
Anatomy of the Head

• Scalp
• Skin
• Subcutaneous connective tissue
• Aponeurosis
• Loose connective tissue
• periosteum

5
Anatomy of the Head

• Brain
• Meninges
• Dura Mater
• Arachnoid Mater
• Pia Mater
• cerebrospinal fluid

6
Anatomy of the Head

• Dura Mater
• dense, fibrous, inelastic sheath next to the
  periosteum
• functions to protect the brain from injury if
  skull is fractured, (limits movement of brain)
• Contains CSF

7
Anatomy of the Head

• Arachnoid Mater
• Delicate, slippery, elastic, cobweb like
• Applied to dura but not attached
• Separated from pia by CSF
• Contains cerebral veins
• Provides little support
• Shearing can occur with sudden movement
• Blood will spread freely if cerebral arteries are
  ruptured (will see blood in CSF not good)

8
Anatomy of the Head

• Subarachnoid space
• The space between the arachnoid and pia mater
• Contains CSF
• Pia mater
• Delicate, thin membrane
• Follows brain and holds small blood vessels close
  to surface
• Highly vascularized

9
Assessing Head InjuriesConscious Athlete
History

• Determine level of consciousness
• ABCs
• How did this happen?
• Is there pain in the neck?
• Where are you?

• Symptoms
• Headache
• Dizziness
• Vomiting
• Ringing in ears
• Changes in personality
• Speech changes

10
Assessing Head InjuriesConscious Athlete

• Observation
• Fluid from ears, nose, eyes, mouth
• Lacerations, bruises, swelling, bleeding
• Alertness
• signs

11
Assessing Head InjuriesConscious Athlete

• Palpation
• Gentle touch to determine areas of sensitivity or
  deformity

12
Assessing Head InjuriesConscious Athlete

• Special Test
• Eye function
• Tracking, vision near and far
• Balance Test
• Drifting, Rhombergs sign
• Coordination Test
• Finger to nose, combination lock
• Cognitive Test
• Serial 7s, months of year backwards

13
Assessing Head InjuriesUnconscious Athlete

• Follow guidelines to assess unconscious athlete
• Determine level of consciousness and activate EAP
  
• Determine treatment
• CPR
• AR
• C-spine collar and spine board

14
Recognition and Management of Specific Head
Injuries
15
Skull Fracture

• Etiology
• Blunt trauma
• Symptoms and Signs
• Severe headache
• Nausea
• Bleeding from ears, nose, (raccoon eyes)
• CSF, (straw coloured) from ears or nose
• Management
• EAP, immediate hospitalization to avoid
  complications from intracranial bleeding

16
Cerebral Concussion

• A clinical syndrome characterized by immediate
  and transient posttraumatic impairment of neural
  functions, (Arnheim)

17
Cerebral Concussion

• Etiology
• Direct blow, (contrecoup)
• Shaking of the brain
• Symptoms and Signs
• Headache,
• tinnitus,
• nausea,
• irritability,
• confusion,
• disorientation,
• dizziness,

• loss of consciousness
• Posttraumatic amnesia
• Retrograde amnesia
• Difficulty concentrating
• Blurred vision
• Photosensitivity
• Sleep disturbance

18
Cerebral Concussion

• Management
• Returning to sport after head trauma
• normal neurological function
• normal in all vasomotor functions
• free of headaches
• free of seizure - normal electroencephalogram
• free of light-headedness when suddenly changing
  body positions

19
Cerebral Concussion

• Classification of Concussions
• Colorado
• American Academy
• McGill

20
Post Concussion Syndrome

• Etiology
• may appear with mild or sever concussion, poorly
  understood
• Symptoms and Signs

• persistent headache,
• impaired memory,
• lack of concentration,
• anxiety,
• Irritability,

• Giddiness,
• fatigue,
• depression,
• visual disturbances

• Symptoms may begin immediately or several days
  after trauma and may last weeks or months.

21
Post Concussion Syndrome,

• Management
• not clear, no return to activity until symptom
  free, follow guidelines

22
Second Impact Syndrome

• Etiology
• rapid swelling and herniation to brain, when
  second head injury occurs before previous injury
  heals. The impact may be minor and may not
  involve a blow to head.
• Symptoms and Signs
• often no loss of consciousness.
• mortality rate high.
• condition worsens rapidly.
• Management
• Must see Dr.
• May require EAP

23
Epidural Hematoma

• Etiology
• A severe blow to the head, skull fracture or
  sudden brain shift
• causes bleeding between the dura and periosteum
• a ruptured artery in the dural membrane
• Symptoms and Signs
• Typically brief concussion,
• Usually but not always loss of consciousness,
  followed by a lucid interval, usually lasts hours
  (24 --48), rarely days.
• Deterioration of vital signs
• This is a life threatening injury
• Management
• EAP and monitor vital signs.
• Need to have pressure surgically removed as soon
  a possible.

24
Subdural Hematoma

• Etiology
• Contrecoup or rotational acceleration/deceleration
  head trauma
• veins between brain and dura mater are torn
  slower
• occurs more frequently than epidural haematoma
• Symptoms and Signs
• may have loss of consciousness, become lucid and
  then deteriorate.
• headache, nausea, vomiting, irritability,
  diplopia, paralysis of contra lateral
  extremities, coma, rapid progression
• Management
• This is life threatening and requires immediate
  medical attention
• Activate EAP

25
Recognition and Management of Specific Head
Injuries

• Cerebral Contusion
• Etiology
• Intracranial bleeding
• Impact from head striking immovable object
• Symptoms and Signs
• Loss of consciousness
• Headaches, dizziness, nausea
• Management
• Varies according to injury
• May require hospitalization

26
Recognition and Management of Specific Head
Injuries

• Scalp Injuries
• laceration, abrasion, contusion, hematoma
• Etiology
• Symptoms and Signs
• Management