Concussion Flashcards
Describe the basic pathophysiology of concussion
- Abnormal exchange of sodium and potassium
- Excessive production of glutamate
- Interferes with the cells communication
- Results in Axonal Dysfunction or Axonal Death
What is the potential reason for cognitive defects for 7-10 days after concussion?
- To restore cerebral homeostasis, the membrane ionic pumps work at an accelerated rate
- This requires extra ATP and Glucose
- Increased metabolic demand often not met with enough blood flow to support it
What are signs and symptoms of post concussive syndrome?
- Headache
- “In a fog”
- Emotional changes
- Amnesia
- Behavioral changes
- Sleep disorders (sleeping more or less than normal)
- Altered cognition
- Diminished reaction time
- Dizziness or gait alteration
What are additional Long Term Symptoms of Post Concussive Syndrome?
- Dementia
- Parkinsonism
- Amyotrophic lateral sclerosis (ALS)
- Chronic traumatic encephalopathy
The severity of Traumatic Brain Injuries is directly related to what?
- Amount of force produced by the collision
- Ability of anatomical structures to absorb the energy
- Ability of the protective equipment to dissipate and absorb the energy produced
What type of weight training program should all athletes perform to prevent concussion?
- Cervical Strengthening
What percent of acute concussions go unreported?
- 50%
What is the primary concern with an athlete who has been recently concussed?
- Airway, Breathing, Circulation
- If athlete responding to verbal questioning, not a concern
How do you treat the unconscious athlete in regards to cervical spine?
- Manage as though unstable spine is present
- Log roll if necessary to preserve airway
- Face mask removed
- Transfer to spine board
- Do not remove helmet on field unless it prevents stabilization of the spine or face mask cant be removed in reasonable amount of time
What is the first part of the exam for a conscious athlete who received a concussion?
- Eye to Eye contact
How do you manage the conscious athlete with a concussion on the field who complains with neck pain, spasm or has deformity?
- Remain on the field in a supine position
- Face mask should be removed
- Athlete managed as though an unstable cervical spine is present
If no indications of unstable C Spine are present, what is initial management of concussion on the field?
- Assist to sitting
- While palpating c spine, AROM is assessed in all directions while equipment still on
- If athlete complains of C Spine symptoms or has “bony block”, return to supine, treat as unstable
- If not, Assist to standing and walk off the field
What is the initial sideline evaluation of the conscious athlete with concussion?
- MOI Description
- C Spine ROM and palpation performed again
- If not painful, remove helmet
- If pain during helmet removal, return helmet to head, treat as unstable
- Perform MMT and Myotome testing
Describe the Myotomes/ Myotomal testing done on the sidelines.
- C4 - Shoulder elevation
- C5 - Shoulder abduction
- C6 - Elbow flexion
- C7 - Elbow extension
- C8 - Grip and thumb extension
- T1- Dorsal and palmar interossei
Describe Cranial Nerves tested on the sidelines
- CN II - Optic, Vision
- CN III - Occulomotor – eye movement medial/ lateral/superior/inferior
- CNIV - Trochlear – eye movement diagonal
- CN VII - Facial – control of the musculature of the face
What are the Cranial Nerves?
- Olfactory
- Optic
- Oculomotor
- Trochlear
- Trigeminal
- Abducens
- Facial
- Vestibular
- Glossopharyngeal
- Vagus
- Spinal Accessory
- Hypoglossal
What is the function of the Olfactory Nerve?
- Smell
What is the function of the Optic Nerve?
- Vision
What is the function of the Oculomotor Nerve?
- Innervates ciliary, sphincter pupillae and all the external eye muscles except: superior oblique and lateral rectus
What is the function of the Trochlear Nerve?
- Innervates superior oblique eye muscle
- Abduction, depression and internal rotation of the eye
What is the function of the Trigeminal Nerve?
- Sensory innervation of the face, sinuses and teeth
What is the function of the Abducens Nerve?
- Innervates the lateral rectus muscle of the eye, which retracts the eye within the orbit
What is the function of the Facial Nerve?
- Muscles of the face
- Taste sensation to the anterior two thirds of the tongue
What is the function of the Vestibular Nerve?
- Innervation to the inner ear
What is the function of the Glossopharyngeal nerve?
- Taste for the posterior third of the Tongue
- Sensation to the tonsils, pharynx and middle ear
- Motor to the stylopharyngeus muscle and the parotid gland
What is the function of the Vagus Nerve?
- Motor and Sensation for Heart, Lungs, GI and much more
- Parasympathetic fibers to viscera
What is the function of the Spinal Accessory Nerve?
- Upper Trapezius Motor
What is the function of the Hypoglossal Nerve?
- Muscles of the tongue
How should you evaluate the somatosensory system in the conscious athlete with concussion?
- After Cranial Nerve Exam
- Coordination tests such as Finger to nose, Romberg, and Bess
What are some standardized tests given to concussed patients for cognitive functioning?
- Standardized Assessment of Concussion (SAC)
- Immediate Post Concussion Assessment and Cognitive Test (IMPACT)
After the initial sideline evaluation, the acutely concussed athlete should be monitored for what?
- Changes in vital signs (i.e., pulse, respiration, blood pressure)
- Increasing complaints related to neurological function (headache, photophobia, dizziness, etc)
- If above symptoms change, activate emergency response system and get athlete to ER, could be indication of serious neurological condition
Follow ups after the initial sideline eval for the acutely concussed athlete should be performed at what time points?
- 1-3 hours
- 24 hours
In general, what should return to play criteria be based on after concussion?
- Resolution of physical symptoms (headeache, dizziness, etc)
- Return of cognitive status to pre-determined normal levels
- No one test should be used as a standard for return to play
What types of medication should not be used to treat headache after concussion?
- Aspirin Products
Describe how to find target heart rate based on Karvonens Formula
- Max heart rate (HR) (220- age) - Resting HR X percent
+ Resting HR - Max HR - Resting HR; Take that number, multiply by percentage of heart rate you want; then add your resting heart rate back in.
- Example: 220-20=200-70(rest) =130 X 50 percent=
65 + 70 = 135 (50 percent THR)
Describe the 5 stages of return to play after concussion and associated target heart rates
- Stage 1 - No activitiy, Absolute rest - THR 30-40%
- Stage 2 - Light Aerobic activity - THR 40-60%
- Stage 3 - Sport Specific Training - THR 60-80%
- Stage 4 - Full Contact - THR 80%
- Stage 5 - Return to Play - Full Exertion
Describe Second Impact Syndrome?
- Another concussion before the first one has completely resolved
- Potentially Fatal
- Because of complete loss of auto regulation of blood supply to brain and causes uncontrolled swelling of the brain
- Presentation of rapid deterioration of neurological status and collapse
- 50% Mortality
