1: Head Injuries Flashcards
Direct force at point of contact may not be solely responsible for _____ of injury. Especially if there is a high rotational component.
Direct force at point of contact may not be solely responsible for severity of injury. Especially if there is a high rotational component.
T/F PE for concussions should include looking for fluid from ears/nose.
True
What is the Concussion QuickCheck App?
Designed by AAN to help coaches, parents and athletes evaluate for concussion. Includes:
Common signs and symptoms of concussion.
Things the athlete may tell you.
What to do if an athlete has a head injury or concussion during a game.
When an athlete should return to play.
State laws on concussion.
Neurologist GPS search.
Why is postconcussive syndrome controversial?
Absence of objective neuro findings.
Inconsistent presentation.
Poorly understood patho.
T/F While a player is on the sidelines with a concussion, repeat exam q 15 minutes until symptoms are cleared.
True
Cognitive S/S of concussions (4).
Irritability
Nervousness/anxiety
Depression
Emotional lability
The effects of multiple concussions over time remains significant. It can result in long-term neuro and functional deficits. What is this called?
Repetitive head injury
Significant sway on Romberg tests suggests _____.
Significant sway on Romberg tests suggests persistent injury.
Persistent vomiting, worsening headache, increasing disorientation, and changing LOC are signs of what?
Elevated ICP
When should a player be allowed to return to play after treatment for concussion?
Must be completely asymptomatic. Have pt jog, sprint, or perform sit-ups to see if symptoms return.
Why are children more susceptible to shear injuries?
Brain is unmyelinated in infants and young children.
Amnesia can be present with concussions. _____ is generally very brief. _____ can be seconds to minutes.
Amnesia can be present with concussions. Retrograde is generally very brief. Anterograde can be seconds to minutes.
Mechanism of injury:
Direct injury to brain at point of contact (coup).
Compressive forces
Why are children more prone to injury from shaking?
Children’s brains have higher water content (88% vs 77%). More prone to acceleration-deceleration injuries.
What is the most common type of traumatic brain injury (TBI)?
Concussion 75%
Physical S/S of concussions (6).
Headache N/V Dizziness Ataxia Fatigue Photo/phonophobia
What are the highest-risk sports for concussions by sex?
Boys: Football and hockey
Girls: Soccer and basketball
When is a CT vs MRI chosen for concussions?
CT: Typical in ER. Can quickly r/o bleeds.
MRI: Prolonged symptoms. Detects more subtle changes not seen on CT.
T/F Child should be closely monitored for the next 24 hours. Parent should wake the child q 4 hours.
False. Parent should wake the child q 2 hours, as neuro deterioration can occur during sleep.
Mechanism of injury:
Can result in shearing of axons.
Rotational forces
With the exception of _____, concussion rates are higher during games than practices. Some sports have higher incidences of concussion based on position played.
With the exception of volleyball, concussion rates are higher during games than practices. Some sports have higher incidences of concussion based on position played.
What is second-impact syndrome?
Second head injury occurs before symptoms from first injury heal. LOC not required for diagnosis.
Red flags of concussions (13).
Weakness, numbness, or decreased coordination. Worsening headaches. Repeated n/v. Slurred speech. Anisocoria (unequal pupils). Seizures. Inability to wake pt or drowsiness. Increasing confusion, agitation, restlessness. Focal neuro signs. Inability to recognize people/places. Neck pain. Unusual behavior changes. LOC over 30 seconds.
Helmets can help prevent concussions. What is the issue with them?
Study found only 15% fit properly.
When is a pt sent for imaging with a concussion (4)?
Focal neuro signs
Signs of increased ICP
Low Glasgow coma scale score
Seizures related to trauma
Postconcussive syndrome is most commonly accepted as occurring within what timeframe after initial injury?
Several weeks
When should a player be allowed to return to play from the sidelines?
If symptoms or physical exam results return to normal within 15 minutes.
What age range has the most head injuries with recreational activities?
10-14 yo
Why can infants and young children tolerate increased ICP better?
Unfused sutures
Mechanism of injury:
Injury at point opposite contact (contrecoup) because axons and nerves are stretched.
Tensile forces
When is chronic postconcussive syndrome usually seen?
Boxing
There is no consensus on return-to-play guidelines, but most agree that symptoms must resolve both at _____ and with _____ before clearance to play is granted.
There is no consensus on return-to-play guidelines, but most agree that symptoms must resolve both at rest and with exertion before clearance to play is granted.
What is the largest cause of head injuries?
MVAs 27-37%
Suspected abuse 30-40% (esp children under 2)
What is the risk with second-impact syndrome?
SIS can cause cerebral edema and herniation, leading to death.
Postconcussive syndrome symptoms (8).
Headache Dizziness Fatigue Irritability Emotional lability Impaired memory and concentration Insomnia Lower tolerance for noise and light
A trauma-induced alteration in mental status that may or may not involve loss of consciousness.
Concussion
A _____ is a type of mild traumatic brain injury.
A concussion is a type of mild traumatic brain injury.
Sleep S/S of concussions (2).
Sleeping more/less than usual
Trouble falling asleep
What is the treatment for postconcussive syndrome?
Nonnarcotic analgesics
Antiemetics
