Concussions Flashcards

1
Q

definition: concussion

A

trauma induced alteration in mental status that may or may not involve transient loss of consciousness

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2
Q

how is the concussion injury described?

A
  • functional disturbance rather than a structural injury

- diffuse axonal injury

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3
Q

what are the MRI and CT scan findings in a concussion?

A

normal

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4
Q

what is the most common reason for lack of concussion reporting?

A

did not think it was serious enough

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5
Q

what is the proposed pathophysiology in concussion injury?

A
  • increased potassium activates ATP dependent Na/K pumps, creating a need for more glucose and adding to the metabolic stress
  • glutamate increases extracellularly and may contribute to increased potassium influx
  • brain’s need for glucose increases acutely and cerebral blood flow and oxidative metabolism are reduced
  • sometimes called disruption of metabolic autoregulation
  • increase in intracellular calcium may be related to regional reduction of cerebral blood flow
  • frontal and temporal hypometabolism during working memory tasks
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6
Q

what are the current sideline evaluation recommendations?

A
  • no return to play same day as a head injury

- if head injury is suspected, player is done for game/day regardless of whether or not symptoms resolve

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7
Q

what is the late / delayed evaluation?

A
  • head injuries should be reassessed within 24 hours
  • repeat much of the sideline evaluation
  • use family members to corroborate athlete’s story and symptoms
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8
Q

what is the cornerstone of concussion management?**

A

physical AND cognitive REST until symptoms resolve and then a graded program of exertion prior to medical clearance and return to play

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9
Q

what is the step wise process for return to play?

A
  1. REST
  2. INCREASE HR
  3. ADD MOVEMENT (sport specific)
  4. EXERCISE, COORDINATION, INCREASE COGNITIVE LOAD (non contact training drills)
  5. RESTORE CONFIDENCE AND ASSESS FUNCTIONAL SKILLS
  6. GAME PLAY
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10
Q

how long should each step take in the return to play protocol?

A

24 hours

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11
Q

what do you do if symptoms occur during a return to play phase?

A

drop back a level and retry after 24 hours

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12
Q

what is the typical treatment for concussions?

A
  • time and waiting
  • possible pharmacological intervention
  • possibly sports psychology
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13
Q

do helmets prevent concussions? what about mouthguards?

A

NO and NO

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14
Q

what can be done to help prevent concussions?

A
  • rule changes

- education

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15
Q

what are the advantages of NPT?

A
  • assessing if head injury if there is a question of concussion
  • monitoring recovery phase of mTBI
  • can help in return to play decisions
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16
Q

what are the disadvantages of NPT?

A
  • financial
  • can be too sensitive
  • need time and expertise to administer to athletes before every season
  • athletes intentionally score low pre-season so that if they have a concussion, they can return to play sooner