Concussions Flashcards
Define Concussion
Temporary loss of brain function due to head injury
Mechanisms of Injury
Coup
Countercoup
Rotational
Deceleration
How to diagnose
History Signs Symptoms Exam findings Neurocognitive testing Balance testing
Cognitive Symptoms
Feeling "dinged/foggy" Inability to focus attention Cognitive slowing, confusion, amnesia Memory dysfunction Inappropriate emotions Fatigue
Physical symptoms
Double vision, seeing stars Headaches, tinnitis Dizziness, nausea Balance problems Sleep disturbances Vacant stare Poor coordination Slow to follow commands/answer question Poor concentration Slurred or incoherent speech Behavior/personality changes Reckless playing behavior Loss of consciousness
Initial Evaluation- Mental status testing
Orientation
Concentration (subtraction from 100)
Memory (details of contest)
Initial Evaluation- Gait Assessment
Have patient walk
Tandem gait
Romberg
Signs demanding emergency action
Increasing headache, N/V Progressive impairment of consciousness Gradual rise in BP Diminution of the pulse rate Blown pupil Disorientation
Emergent Referrals
Suspicion for hematoma C-spine injury Worsening LOC Focal motor weakness Transient quadriparesis Seizure
Referral
Persistant headache >7 days Post concussion syndrome >2 weeks Abnormal neurpsych testing Hx of multiple concussions Clinical judgement
Other disorders concussions can mimic
Substance abuse/dependency Intermittent explosive disorder Suicidal ideation/tendencies Depression Mood disorder Impulse control
On field evaluations
ABC’s
Loss of consciousness (cervical spine injury)
Signs of neurological deficits (ER transfer)
Sideline evaluations
Signs, symptoms
Mental status
Gait assessment & balance
Problems with sideline evaluations
Everyone wants to know consequences of concussion
Can occur on any play
Dx difficult if athlete doesn’t report
Post game evaluation
Similar to sideline Determine if additional testing needed Take home instructions Coordinate care and follow up of athlete Discuss status of athlete with parents, coaching staff, AT
Indications for transfer to emergency department
Loss of consciousness Possible cervical spine injury Possible skull fracture High risk for intra-cranial bleeding Post-traumatic seizure Acute worsening of mental status
Treatment of Mild Concussions
Rest, fluid, good nutrition
Physical rest
Cognitive rest (no TV, video games, texting, music)
Avoid NSAIDs
Avoid activities with risk for head injury
Exertion protocol
Must pass exertion tests without symptoms
Is athlete eager to return
Consider protective equiptment
Career ending
Rule of 3’s
1 concussion- out of game/practice for several days
2 concussions- out for season
3 concussions- out of the sport
Return progression
Symptoms at any point, regress to previous step
Aerobic exercise
Sport specific activities without opponent
Non-contact drills
Full-contact drills
Return to game play
Second Impact Syndrome
Second impact to the brain while recovering from first concussion
May be minor/incidental injury
Can lead to worsening mental status
Prevention
Can't condition the brain Rule changes if clear cut cause Protective equipment Promote fair play Teach players to play under control, how to fall, protect self
Repeated Injury
Post concussive syndrome
Headaches/sleep disorders
Depression or dementia
Chronic traumatic encephalopathy
Post concussive syndrome
Chronic cognitive and behavioral symptoms
Headaches, fatigue, sleep difficulties, concentration issues, emotional problems, dizziness
Affect sport, academics and life
Need physical and cognitive rest
PT may be helpful
Beware of depression
