Concussion Management Flashcards
1
Q
Concussion Definition
A
- Sport-related concussions a traumatic brain injury caused by a direct blow to the head, neck or body resulting in an impulsive force being transmitted to the brain that occurs in sports and exercise-related activities
- This initiates a neurotransmitter and metabolic cascade, with possible axonal injury, blood flow change, and inflammation affecting the brain.
- Signs and symptoms may present immediately or evolve over minute or hours, and commonly resolve within days, but may be prolonged.
2
Q
What does a concussion entail?
A
- Functional injury
- Acceleration or deceleration injury of the brain
- Do not have to be ht in the head to have a concussion
- No abnormality seen on standard neuroimaging
- Brain is like Jell-O and neurons get stretched
- Depolarization of neurons (number of symptoms)
- Energy crisis
3
Q
Mechanism of concussion
A
- What sports put athletes at risk?
- What ‘mechanism’ causes concussion?
- Direct Blow
- Indirect Blow
4
Q
Concussion Diagnosis
A
- Mechanism of concussion
* Acceleration/deceleration of brain
* Direct impact - One symptom
* Headache, dizziness, neck pain
5
Q
Signs and symptoms of a concussion
A
- Symptoms: Headache, dizziness, emotional symptoms, feeling like in fog
- Physical signs: Loss of consciousness, amnesia, neurological deficit
- Balance impairment: unsteady gait
- Behavioural changes: irritability
- Cognitive impairment: slowed reaction time
- Sleep/Wake disturbances: drowsiness
6
Q
Observable Signs
A
- Lying motionless on playing surface
- Balance/gait difficulties/motor incoordination (stumbling, slow/laboured movement)
- Disorientation or confusion, or an inability to respond appropriately to questions
- Blank or vacant look
- Facial injury after head trauma
7
Q
Suspected Concussion - on field
A
- Athlete down on field
1. Stabilize the neck and instruct not to move
- “What is your name?” (1st question always)
- If responsive, ask the following questions (orientation)
* Where are you? What day is it? What is the score? - What are you feeling? (symptoms)
*HA, dizziness, nausea, ringing in ears, blurry? - Do you have any pain in your neck?
- Do you have any pain in your
arms/legs? - Assess sensory of extremities while stabilizing the neck
- Assess active movement of
extremities - Have athlete rotate neck side to
side (must be able to turn head >45˚ each direction without pain)
8
Q
Suspected Concussion - sidelines
A
- If athlete comes off under own power, but you are suspecting concussion
- Sit them down immediately
- Maddock’s questions (tailor to sport)
- Where are we today? (venue)
- What period/half is now?
- Who scored last in this match?
- What team did we play last
week/game? - Did your team win the last game?
- Ask about their symptoms
- if any symptoms, pull from the game
- No medications
- SCAT-6
- Remove gear and sit in shade
9
Q
Concussion Diagnosis
A
- Rule out cervical fracture or more serious injury
- Do not leave athlete alone
- When in doubt, sit them out!
- Monitor for 2-3 hours
- Do not allow athlete to sleep for at least 3 hours after concussion
- No longer need to wake up throughout first night
10
Q
Red Flags for concussion
A
- Neck pain or tenderness
- Double vision
- Weakness or tingling/burning in arms or legs
- Severe or increasing headache
- Seizure or convulsion
- Loss of consciousness
- Deteriorating conscious state
- Vomiting
- Increasingly restless, agitate or combative
11
Q
Concussion for parents/coaches
A
- If you observe any of the following or are unsure, go to ER
- Severe or worsening headache
- Very drowsy or can’t be awakened
- Seizures
- Decreasing level of consciousness >2 hours after injury (cannot
recognize people or places) - Unusual behaviour, very confused, very irritable
- Weakness or numbness in arms or legs
- Unsteady on feet or have slurring of speech
- Fluid leaking from ears, bruising behind ears, 2 black eyes
- Vomiting
- Inability to remember more than 30 minutes before the injury
12
Q
Concussion Assessment
A
- Vital Signs: to establish baseline
- Physical signs: pupil abnormalities
- Cognitive Assessment
- Balance Assessment
-Coordination Assessment
- Sport Concussion Assessment tool (SCAT-6)
- Assesses these elements
- Standardized tool for evaluating concussions
- Used for athlete 13 years and older
- 12 year and younger use Child SCAT-6
13
Q
SCAT-6 test
A
- 10 – 15 minutes to perform
- Complete as baseline or within first 72 hours of concussion
- Immediate assessment tool (maximum utility)
- Return to play or >72 hours use SCOUT 6 (Sport Concussion Office
Assessment Tool)
14
Q
Concussion Management
A
- Diagnosis has beed made and red flags ruled out
- Eduction & reassurance
- One of the best ways to reduce the incidence of persistent symptoms
- What is a concussion? Your brain is not damaged – this is temporary
- What are you likely to experience?
- What things you can do to improve your outcomes? Sense of control
- Prognostic Variables
- High symptoms severity score (also related to anxiety & poor coping skills – increased
education & reassurance needed) - Pre-existing mental health status (anxiety & depression)
- Early removal from play
- Male/female
- Time from injury assessment
15
Q
Rest after a concussion
A
- There is currently insufficient evidence that prescribes complete rest
-After a brief period of rest during the acute phase (24-48 hours) after injury, patients can be encouraged to become gradually and progressively more active
- Stay below their cognitive and physical symptoms worsening
