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Clin Med II - Ortho > Concussions > Flashcards

Concussions Flashcards

1
Q

Concussion - Definition

A

Clinical syndrome characterized by an immediate and transient impairment of normal neurological function

Brain injury defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces

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2
Q

Concussion facts

A

Functional disturbance rather than a structural disturbance
Majority resolve in 7-10 days
Caused by direct or indirect forces - over 100 G-forces in football impacts
Typically rapid onset, but some s/s may take a few hours to develop
Typically s/s do not significantly worsen over time and new ones to do not appear
Clinical neurological signs typically are not present
A concussion will not show on dx imaging

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3
Q

Clinical domains of a concussion

A

Physical signs
Behavior changes
Cognitive impairment
Sleep disturbance

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4
Q

Physical signs of concussion

A 
Loss of consciousness
Loss of balance
Vomiting
Visual
Ha
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5
Q

Behavior changes associated with concussion

A

Irritability
Aggression
Sadness

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6
Q

Cognitive impairment associated with concussion

A

Delayed reaction
Lack of concentration
Amnesia

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7
Q

DDX

A

Concussion
Diffuse axonal injury
Vascular rupture
Fx - laceration of brain

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8
Q

Concussion dx

A

Dx of exclusion - need to r/o more serious pathology

R/o non-trauma and other trauma related conditions

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9
Q

R/o non-trauma related causes

A 
Stroke
Tumor
Meningitis
Aneurysm
Heat stroke
DM conditions
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10
Q

R/o other trauma related conditions (direct or indirect)

A 
Cranial fx
Intracranial hemorrhaging (increased intracranial pressure)
- subdural hematoma
- epidural hematoma
- intra-cerebral hematoma
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11
Q

Concussion - dx and managment (in a nutshell)

A
  1. Primary survey? CABs
  2. Hx
  3. Observation
  4. Palpation?
  5. Special Testing
    - r/o s/s of increased ICP
    - symptomatic baseline testing
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12
Q

Concussion - hx

A

When did injury occur?
MOI
PMH of injury (frequency, duration, etc)
Basic s/s check

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13
Q

Concussion - observation

A

Behavior
Thought process
Movement quality

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14
Q

Concussion - Palpation

A

Fx?

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15
Q

Special tests

A

R/o increased intracranial pressure

Baseline concussion assessment

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16
Q

Increased intracranial pressure

A 
S/s of increased intracranial pressure (red flags)
Pathological reflex present
- decorticate /decerebrate rigidity
- Babinski's sign
Increased DTR (hypereflexia)
Hypertonicity (spasticity and rigidity)
Decreased/absent superficial reflexes
CN dysfunction
S/s progressively worsening
Blurring of optic disc and hemorrhaging of retina
Increased BP and PP
Slow irregular pulse
Prolonged loss of consciousness
Seizure
Overall deterioration
GCS <15
17
Q

GCS Categories

A

Eye Opening response
Best verbal response
Best motor response

18
Q

GCS - eye opening responses

A

Spontaneously - 4
To speech - 3
To pain - 2
No response - 1

19
Q

GCS - Best verbal response

A 
Oriented to time place &amp; person - 5
Confused - 4
Inappropriate words - 3
Incomprehensible sounds - 2
No response - 1
20
Q

GCS - Best motor response

A 
Obeys commands - 6
Moves to localized pain - 5
Flexion withdrawal from pain - 4
Abnormal flexion (decorticate) - 3
Abnormal extension from pain (decerebrate) - 2
No response - 1
21
Q

GCS Scoring

A

Best response - 15
Comatose client = 8
Totally unresponsive - 3

22
Q

CN Testing

A 
Vision
Visual fields
Eye tracking
Facial sensation
Muscles of facial expression
Muscles of mastication
Hearing / balance
Swallowing
Upper trap / SCM strength
Tongue protrusion
Pupil reflexes
23
Q

Symptomatic Baseline Testing - Tests available

A 
ImPACT
SAC
SCAT 5
CogSTate
ANAM
CogSport
24
Q

ImPACT

A

Immediate Post-concussion assessment and cognitive testing

25
Q

SAC

A

Standardized assessment of concussion

26
Q

SCAT

A 
Sport concussion assessment tool
Free
Easy to administer
Developed by leading experts
Portions are valid/reliable
27
Q

ANAM

A

Automated neuropsychologial assessment metrics

28
Q

When to do symptomatic baseline testing

A

Pre-season baseline testing

Symptomatic baseline testing - not for dx, but for managment

29
Q

Managment

A

Cornerstone is cognitive and physical rest

Graduated return to activity when s/s reside

30
Q

Graduated return to sport

A 
No activity until s/s free for 24-48h
Light aerobic exercise
Sport specific skills
Non-contact raining drills
Full contact drills
Return to full, unrestricted play
24h for each stage if not return of s/s
31
Q

Return to learn

A

Gradual return to learning activities

Rest from cognitive strain

32
Q

VOMS

A

Vestibular Ocular Motor System
Testing & tx
Provocation of s/s
Helps with dysfunction between eyes & ears

33
Q

Concussion management modifiers

A 
Age
Seizure d/o
Depression
Extended LOC
Significant amnesia
Duration of s/s
34
Q

Prevention

A

Equipment of little benefit in most sports
Rule enforcement and rule changes
Common sense

35
Q

Grading

A

Not a concern with newer guidelines

36
Q

Second impact syndrome

A 
Patho
Loss of auto-regulation of blood and CSF
Rapid increased ICP and brain herniation
Brain stem failure in 2-5 minutes
Rare and difficult to determine incidence rate
37
Q

Chronic Traumatic Encephalopathy (CTE

A

Patho
Atrophy of the brain
Neuronal loss
Protein build-up

Clin Med II - Ortho (13 decks)

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