Head Injuries

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Head Injuries

• Care Prevention of Athletic Injuries
• Ms. Herrera ATC/L

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Anatomy

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

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Anatomy Contd

• CNS is comprised of the brain and spinal cord.
• Functions of the
• Cerebrum
• Cerebellum
• Pons
• Medulla Oblongata

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Anatomy Contd

• Meninges
• 3 layers
• Dura Mater, Arachnoid, and Pia Mater
• Subdural space divides the dura and arachnoid
  space
• CSF function?
• Suspends the brain
• Cushions
• Lessons forces

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General Information

• Head injuries occur in
• Contact and collision sports
• Examples?
• MOI
• Direct blow to the head
• Impact causing the head to snap in different
  directions

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General Signs Symptoms

• Brain injury may result in
• LOC
• Track time of LOC
• Disorientation
• Amnesia
• Motor coordination
• Balance deficits
• Cognitive deficits
• If ath has LOC
• Must consider C-spine injury

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History

• Can you remember the score or who we played last
  week? (retrograde amnesia)
• Can you remember walking off the field?
  (antegrade amnesia)
• Does your head hurt?
• Do you feel nauseous?
• Do you have pain in your neck?
• Can you move your arms and legs?
• Do you remember what happened?

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Observation

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

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Palpation

• ATC should palpate the following for obvious
  deformity
• Neck
• Skull

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Special Tests

• Neurological Exam
• Eye function
• PERRLA
• Nystagmus (demonstrate)
• Balance Tests
• Romberg
• BESS
• Coordination Tests
• Cognitive Tests
• Remember these 5 words
• Say the months backwards

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Cranial Nerves

• Review handout
• Demonstrate

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Skull FX

• MOI Direct blow to the head.
• Examples
• Signs Symptoms (SS)
• Severe headache
• Nausea
• Indentation in skull
• Blood in ear or nose
• Battles sign
• Racoon eyes
• CSF Halo sign
• Management
• Activate EMS
• Refer to neurosurgeon ASAP
• Why???

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Cerebral Concussions

• Definition Immediate and transient impairment
  of brain function affecting equilibrium and
  disrupting consciousness.

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Concussions

• MOI
• Direct blow
• COUP injury stationary skull hit at a high
  velocity. Injury on same side.
• Counter-coup Skull moving at high velocity,
  stops suddenly, and strikes a surface causing
  damage to the opposing side of impact.
• Acceleration/deceleration forces causing the
  brain to shake.

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Concussions SS

• Postraumatic Amnesia
• Antegrade vs retrograde
• Loss of balance
• Behavior (not themselves)
• Loss of CN function
• Diminished neurological function
• Confused
• Vacant stare
• Lack of focus
• Delayed Responses
• LOC
• Emotions out of proportion
• Slurred speech

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Management

• LOC, suspect C-Spine
• Spine board and transport to ER via EMS
• CT Scan
• If no LOC
• Evaluate on sideline
• Track postconcussive signs and symptoms
• Monitor
• Not released until no ss are present
• Different scales
• When to grade a concussion?

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Second-Impact Syndrome

• Occurs when an ath sustains a 2ND blow to the
  head, while still recovering from a previous
  concussion.
• Second blow can be minimal.
• Causes swelling in the brain
• ? intracranial pressure
• Initially, ath appears normal
• Moments later.
• Mortality rate of 50
• Management?

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Cerebral Contusion

• MOI Impact with a stationary object
• Causes bleeding in the brain.
• SS
• LOC
• Headaches
• Dizzyness
• Nausea
• Management Refer to ER
• CT Scan or MRI

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Epidural Hematoma

• Hematoma between the skull and dura mater.
• SS
• Severe head pain
• Dizziness
• Lucid interval
• Nausea
• Dilation of 1 pupil
• Sleepiness
• Management Refer to ER
• CT scan
• Delayed medical attention can result in death or
  permanent disability
• May be confused for mild concussion.

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Subdural Hematoma

• More common than epidural hematomas
• Most common cause of death in athletes
• MOI deceleration/acceleration forces
• SS same as epidural
• Management
• Activate EMS
• Emergency!

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Scalp Injuries

• MOI Blunt trauma causes laceration
• Could cause brain injury
• SS
• Profuse bleeding
• Makes it difficult to?
• Pain
• Management Refer to ER
• Requires stitches
• CT scan to r/o brain injury