Injuries to the Head, Neck & Injuries to the Head, Neck & SpineSpine

Cerebral ConditionsCerebral Conditions

Impact or injuries causes bleeding Impact or injuries causes bleeding within the brain called HEMATOMASwithin the brain called HEMATOMAS

ArteryArtery damaged: quick decline in damaged: quick decline in mental status and functioning of the mental status and functioning of the brain (10 – 20 minutes)brain (10 – 20 minutes)

VeinVein damaged: slower onset (24 to 72 damaged: slower onset (24 to 72 hours), slower bleeding and swellinghours), slower bleeding and swelling

Both are life-threatening!!!!!!Both are life-threatening!!!!!!

ConcussionsConcussions

Definition = the temporary impairment of Definition = the temporary impairment of brain function caused by impact to the head, brain function caused by impact to the head, or rotational forceor rotational force

Usually caused by a direct hit to the head, Usually caused by a direct hit to the head, plus the injury to the opposite side of the plus the injury to the opposite side of the brain where the brain bounces off of the brain where the brain bounces off of the skull.skull.

The more concussions you sustain, the more The more concussions you sustain, the more severe they become, and the easier it is to severe they become, and the easier it is to get one!get one!

ConcussionsConcussions

FootballSoftball

Basketball

MechanismsMechanisms

Direct impact causes two conditionsDirect impact causes two conditions 1. deformation1. deformation 2. acceleration2. acceleration

Direct blow can cause fracture at the Direct blow can cause fracture at the site of impactsite of impact

Direct blow can cause fracture at site Direct blow can cause fracture at site away from area of impactaway from area of impact

Signs and SymptomsSigns and Symptoms Dizziness Headache Excessive Drowsiness Unable to focus or

concentrate»Irritable and Confused » Convulsions* Nystagmus*Visual problems- Bleeding from nose or ears-Tinnitus (ringing in ears)~Paralysis~Weakness in limbs or face∞Memory problems∞Balance problemsNauseaVomiting

ConcussionsConcussions Treatment:Treatment:

Careful removal from Careful removal from playplay

Thorough physical and Thorough physical and neurological neurological examinationexamination

Refer to physician for Refer to physician for follow-up examinationfollow-up examination

ConcussionsConcussions Assessment:Assessment:

Neuropsychological TestingNeuropsychological Testing If possible, preseason testing on a computerized If possible, preseason testing on a computerized

system (ImPACT).system (ImPACT). If a concussion occurs, retest injured athlete If a concussion occurs, retest injured athlete

following recommended protocols.following recommended protocols. Thorough evaluation of athlete: Thorough evaluation of athlete:

(Sport Concussion Assessment Tool (SCAT 2) is a (Sport Concussion Assessment Tool (SCAT 2) is a tool that can be used to evaluate a concussed tool that can be used to evaluate a concussed athlete.athlete.

Physical Examination – evaluation of athletes Physical Examination – evaluation of athletes physical symptoms as listed previously.physical symptoms as listed previously.

Assessment of ConcussionsAssessment of Concussions

ConcussionsConcussions AssessmentAssessment

Cognitive testingCognitive testing Immediate memory testingImmediate memory testing

What month is it?What month is it? What time is it?, etc.What time is it?, etc.

ConcentrationConcentration Months of year backwardMonths of year backward 100-7, continue backward100-7, continue backward

Delayed Recall – have athlete remember words, Delayed Recall – have athlete remember words, repeat at later timerepeat at later time

Assessment of ConcussionsAssessment of Concussions

ConcussionsConcussions AssessmentAssessment

Balance/Coordination testingBalance/Coordination testing Balance Error Scoring System (BESS)Balance Error Scoring System (BESS) Romberg TestRomberg Test Finger to NoseFinger to Nose

Assessment of ConcussionsAssessment of Concussions

Common Injuries – Common Injuries – Head/NeckHead/Neck Return to Play Guidelines:Return to Play Guidelines:

Depends on the level of play of the Depends on the level of play of the athlete involved. Currently, the athlete involved. Currently, the NCAA, UHSAA, and a new Utah NCAA, UHSAA, and a new Utah State law regarding youth sports State law regarding youth sports (HB 204) will dictate a specific (HB 204) will dictate a specific plan for concussion management plan for concussion management and return to play guidelines. It and return to play guidelines. It will include some variation of the will include some variation of the following :following :

Progression through Return-To-Progression through Return-To-Play stages on a case by case Play stages on a case by case basis with final clearance by an basis with final clearance by an approved, licensed health care approved, licensed health care professional:professional:

Common Injuries – Common Injuries – Head/NeckHead/Neck

Common Injuries – Common Injuries – Head/NeckHead/Neck

Second Impact Second Impact SyndromeSyndrome

Rapid swelling of the brain from Rapid swelling of the brain from additional head trauma; life additional head trauma; life threateningthreatening

Second impact could be minorSecond impact could be minor Could be caused by blow to Could be caused by blow to

chest that accelerates head.chest that accelerates head.

Signs and SymptomsSigns and Symptoms No initial loss of consciousnessNo initial loss of consciousness Rapid worsening leading to:Rapid worsening leading to:

LOC progressing to comaLOC progressing to coma Dilated pupilsDilated pupils Loss of eye movementLoss of eye movement Respiratory failureRespiratory failure

TreatmentTreatment: Immediate transport : Immediate transport to medical facilityto medical facility

PreventionPrevention DO NOT LET THIS SITUATION DO NOT LET THIS SITUATION

OCCUR!OCCUR! Careful decision making Careful decision making

regarding return to play regarding return to play following initial head traumafollowing initial head trauma

Common Injuries – Common Injuries – Head/NeckHead/Neck Post-Concussion SyndromePost-Concussion Syndrome

Persistent symptoms following concussion Persistent symptoms following concussion - May begin immediately following injury - May begin immediately following injury and may last for weeks to monthsand may last for weeks to months

Persistent headachePersistent headache Impaired memoryImpaired memory Lack of concentrationLack of concentration AnxietyAnxiety IrritabilityIrritability FatigueFatigue Depression Depression Continued visual disturbancesContinued visual disturbances

Treatment – No clear guidelinesTreatment – No clear guidelines Treat symptoms to greatest extent Treat symptoms to greatest extent

possiblepossible Return athlete to play when Return athlete to play when allall signs signs

and symptoms have fully resolvedand symptoms have fully resolved

ESPN ConcussionsESPN Concussions

OTL: College Football Concussions

Scalp InjuriesScalp Injuries Highly vascularized; bleeds freelyHighly vascularized; bleeds freely LacerationLaceration

Control bleedingControl bleeding Prevent contaminationPrevent contamination Assess for skull fracture (fx)Assess for skull fracture (fx) Management: Management:

If no fx, cleanse, cover, and referIf no fx, cleanse, cover, and refer Abrasions and contusionsAbrasions and contusions

Cleanse; ice and pressureCleanse; ice and pressure 24 hours: no improvement – refer24 hours: no improvement – refer

Skull FractureSkull Fracture

TypesTypes LinearLinear Comminuted Comminuted DepressedDepressed BasilarBasilar

Skull Fracture (cont.)Skull Fracture (cont.)

Potential for varying signs and Potential for varying signs and symptoms symptoms Visible deformity–do not be misled by a Visible deformity–do not be misled by a

“goose egg”; a fracture may be under the “goose egg”; a fracture may be under the sitesite

Deep laceration or severe bruise to scalpDeep laceration or severe bruise to scalp Palpable depression or crepitusPalpable depression or crepitus Unequal pupilsUnequal pupils Raccoon eyes or Battle’s signRaccoon eyes or Battle’s sign

Skull Fracture (cont.)Skull Fracture (cont.) Bleeding or CSF from nose and/or earBleeding or CSF from nose and/or ear

Battle SignBattle Sign Raccoon Eye’sRaccoon Eye’s ““Halo” SignHalo” Sign

Loss of smellLoss of smell Loss of sight or major vision disturbancesLoss of sight or major vision disturbances Unconsciousness Unconsciousness 2 minutes after direct 2 minutes after direct

trauma to the headtrauma to the head Management: activation of EMSManagement: activation of EMS

Facial ConditionsFacial Conditions

Facial soft tissue conditionsFacial soft tissue conditions Contusions, abrasions, and Contusions, abrasions, and

lacerations are managed the lacerations are managed the same as elsewhere on the same as elsewhere on the body body

Complicated injuries—Complicated injuries—immediate physician referralimmediate physician referral

Nasal ConditionsNasal Conditions Epistaxis (nose bleed)Epistaxis (nose bleed)

Anterior – bleeding from anterior septumAnterior – bleeding from anterior septumPosterior – bleeding from lateral wallPosterior – bleeding from lateral wall

Management: ice, mild pressure, slight forward head Management: ice, mild pressure, slight forward head tilt; nasal plug; tilt; nasal plug; 5 minutes – physician referral5 minutes – physician referral

Deviated septumDeviated septum S&SS&S

Consistent difference in airflow between the 2 sides of the Consistent difference in airflow between the 2 sides of the nose when one nostril is blockednose when one nostril is blocked

Confirm using otoscope Confirm using otoscope Management: physician referralManagement: physician referral

Nasal Conditions (cont.)Nasal Conditions (cont.)

FracturesFractures Most common: lateral displacementMost common: lateral displacement Range of severity variesRange of severity varies S&SS&S

Asymmetry – especially with lateral forceAsymmetry – especially with lateral force EpistaxisEpistaxis CrepitusCrepitus

Management: control bleeding; referManagement: control bleeding; refer

Ear ConditionsEar Conditions

Cauliflower ear (auricular hematoma)Cauliflower ear (auricular hematoma) Repeated trauma Repeated trauma Untreated – forms a fibrosisUntreated – forms a fibrosis Management: ice; possible aspiration by Management: ice; possible aspiration by

physicianphysician Key is prevention Key is prevention

Eye ConditionsEye Conditions

Preorbital ecchymosis (black eye)Preorbital ecchymosis (black eye) AssessmentAssessment Management: ice, referral to Management: ice, referral to

ophthalmologist ophthalmologist Foreign bodiesForeign bodies

S&S: intense pain, tearingS&S: intense pain, tearing ManagementManagement

Not embedded: removal, inspectionNot embedded: removal, inspection Embedded: do not touch, activate EMSEmbedded: do not touch, activate EMS

Eye Conditions (cont.)Eye Conditions (cont.)

Orbital “blowout” fractureOrbital “blowout” fracture Impact from a blunt object, usually larger Impact from a blunt object, usually larger

than the eye orbit than the eye orbit S&S:S&S:

DiplopiaDiplopia Numbness below eyeNumbness below eye Lack of eye movementLack of eye movement Recessed downward displacement of globeRecessed downward displacement of globe

Management: ice; immediate referral to Management: ice; immediate referral to physicianphysician

Cervical Spine Cervical Spine

FractureFracture S&SS&S

Pain Pain NumbnessNumbness TinglingTingling

ManagementManagement Spinal immobilizationSpinal immobilization Refer to a physicianRefer to a physician

Brachial PlexusBrachial Plexus 31 pairs of spinal nerves31 pairs of spinal nerves

Brachial C5-T1Brachial C5-T1 ““Stinger”Stinger”

NumbnessNumbness Loss of functionLoss of function

ManagementManagement Remove from playRemove from play Allow RTP once Allow RTP once

symptoms resolvesymptoms resolve

Guess the Injury!Guess the Injury!

Ouch…that hurts!Ouch…that hurts!

DIRECTIONS:DIRECTIONS:

For each of the following slides, try to For each of the following slides, try to identify the type of injury that has identify the type of injury that has occurred.occurred.

Write your answer on your paper. Write your answer on your paper.

#1#1

#2#2

#3#3

#4#4

#5#5

#6#6

#7#7

#8#8

#9#9

#10#10

AnswersAnswers1.1. ConcussionConcussion

2.2. Scalp LacerationScalp Laceration

3.3. Battle SignBattle Sign

4.4. Deviated SeptumDeviated Septum

5.5. Foreign objectForeign object

6.6. Preorbital Ecchymosis (Black Eye)Preorbital Ecchymosis (Black Eye)

7.7. Epistaxis (nose bleed)Epistaxis (nose bleed)

8.8. Cauliflower EarCauliflower Ear

9.9. Orbital FractureOrbital Fracture

10.10. Brachial Plexues Brachial Plexues