Concussion Flashcards

1
Q

Describe the basic pathophysiology of concussion

A
  • Abnormal exchange of sodium and potassium
  • Excessive production of glutamate
  • Interferes with the cells communication
  • Results in Axonal Dysfunction or Axonal Death
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2
Q

What is the potential reason for cognitive defects for 7-10 days after concussion?

A
  • 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
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3
Q

What are signs and symptoms of post concussive syndrome?

A
  • 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
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4
Q

What are additional Long Term Symptoms of Post Concussive Syndrome?

A
  • Dementia
  • Parkinsonism
  • Amyotrophic lateral sclerosis (ALS)
  • Chronic traumatic encephalopathy
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5
Q

The severity of Traumatic Brain Injuries is directly related to what?

A
  • 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
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6
Q

What type of weight training program should all athletes perform to prevent concussion?

A
  • Cervical Strengthening
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7
Q

What percent of acute concussions go unreported?

A
  • 50%
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8
Q

What is the primary concern with an athlete who has been recently concussed?

A
  • Airway, Breathing, Circulation

- If athlete responding to verbal questioning, not a concern

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9
Q

How do you treat the unconscious athlete in regards to cervical spine?

A
  • 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
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10
Q

What is the first part of the exam for a conscious athlete who received a concussion?

A
  • Eye to Eye contact
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11
Q

How do you manage the conscious athlete with a concussion on the field who complains with neck pain, spasm or has deformity?

A
  • Remain on the field in a supine position
  • Face mask should be removed
  • Athlete managed as though an unstable cervical spine is present
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12
Q

If no indications of unstable C Spine are present, what is initial management of concussion on the field?

A
  • 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
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13
Q

What is the initial sideline evaluation of the conscious athlete with concussion?

A
  • 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
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14
Q

Describe the Myotomes/ Myotomal testing done on the sidelines.

A
  • C4 - Shoulder elevation
  • C5 - Shoulder abduction
  • C6 - Elbow flexion
  • C7 - Elbow extension
  • C8 - Grip and thumb extension
  • T1- Dorsal and palmar interossei
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15
Q

Describe Cranial Nerves tested on the sidelines

A
  • 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
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16
Q

What are the Cranial Nerves?

A
  • Olfactory
  • Optic
  • Oculomotor
  • Trochlear
  • Trigeminal
  • Abducens
  • Facial
  • Vestibular
  • Glossopharyngeal
  • Vagus
  • Spinal Accessory
  • Hypoglossal
17
Q

What is the function of the Olfactory Nerve?

A
  • Smell
18
Q

What is the function of the Optic Nerve?

A
  • Vision
19
Q

What is the function of the Oculomotor Nerve?

A
  • Innervates ciliary, sphincter pupillae and all the external eye muscles except: superior oblique and lateral rectus
20
Q

What is the function of the Trochlear Nerve?

A
  • Innervates superior oblique eye muscle

- Abduction, depression and internal rotation of the eye

21
Q

What is the function of the Trigeminal Nerve?

A
  • Sensory innervation of the face, sinuses and teeth
22
Q

What is the function of the Abducens Nerve?

A
  • Innervates the lateral rectus muscle of the eye, which retracts the eye within the orbit
23
Q

What is the function of the Facial Nerve?

A
  • Muscles of the face

- Taste sensation to the anterior two thirds of the tongue

24
Q

What is the function of the Vestibular Nerve?

A
  • Innervation to the inner ear
25
Q

What is the function of the Glossopharyngeal nerve?

A
  • 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
26
Q

What is the function of the Vagus Nerve?

A
  • Motor and Sensation for Heart, Lungs, GI and much more

- Parasympathetic fibers to viscera

27
Q

What is the function of the Spinal Accessory Nerve?

A
  • Upper Trapezius Motor
28
Q

What is the function of the Hypoglossal Nerve?

A
  • Muscles of the tongue
29
Q

How should you evaluate the somatosensory system in the conscious athlete with concussion?

A
  • After Cranial Nerve Exam

- Coordination tests such as Finger to nose, Romberg, and Bess

30
Q

What are some standardized tests given to concussed patients for cognitive functioning?

A
  • Standardized Assessment of Concussion (SAC)

- Immediate Post Concussion Assessment and Cognitive Test (IMPACT)

31
Q

After the initial sideline evaluation, the acutely concussed athlete should be monitored for what?

A
  • 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
32
Q

Follow ups after the initial sideline eval for the acutely concussed athlete should be performed at what time points?

A
  • 1-3 hours

- 24 hours

33
Q

In general, what should return to play criteria be based on after concussion?

A
  • 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
34
Q

What types of medication should not be used to treat headache after concussion?

A
  • Aspirin Products
35
Q

Describe how to find target heart rate based on Karvonens Formula

A
  • 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)
36
Q

Describe the 5 stages of return to play after concussion and associated target heart rates

A
  • 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
37
Q

Describe Second Impact Syndrome?

A
  • 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