Exam 1: Head Injury Flashcards
For a coo injury, where is the injury located?
The injury is direct at the point of contact
Compressive forces
For a counter coo injury, where is the injury located?
The injury is opposite from the point of initial direct contact
(Tensile forces)
What assessment/question will allow you to determine the severity of a head injury?
Length of amnesia
What is a concussion?
A trauma-induced alteration in mental status that may or may not involve a loss of consciousness.
T/F: The increased participation in organized sports has increased concussion rates.
False: Concussion rates have dramatically increased even though participation in organized sports has decreased.
Do concussion rates increase during practices or games?
Concussion rates increase during games with the exception of volleyball. Concussion rates with volleyball increases during practices.
Which sports have the highest risk for concussions?
Boys: football and hockey
Girls: soccer and basketball
Overall, what are the major causes of concussion in children of all ages?
MVA
Falls
Child abuse (especially if < 2 yo)
Recreational activities especially in the spring and summer (especially ages 10-14)
What are the signs and symptoms of concussion?
Physical: Headache N/V Dizziness Ataxia Fatigue Photo/phonophobia
Cognitive:
Difficulty concentrating
Difficulty remembering new info
Feeling slowed down
Emotional: Irritability Nervousness or anxiety Depression Emotional lability
Sleep:
Sleeping more or less than usual
Trouble falling asleep
T/F: Alcohol can mask the signs and symptoms of concussion?
True
Also rule out hypoglycemia, drug overdose, hyperthermia, or arrhythmia
What are red flags to look for in concussion?
Send to the ED if: Weak, numb, decreased coordination Worsening headaches Repeated N/V Slurred speech Anisocoria (unequal pupils) Seizures Inability to wake/drowsiness Increased confusion, agitation, restlessness Focal neurological signs Cannot recognize people/places Neck pain Unusual behavior Any LOC > 30 seconds
Which signs/symptoms would indicate elevated intracranial pressure?
Persistent vomiting
Worsening headache
Increasing disorientation
Changing LOC
When assessing for concussion, what will you want to do on the physical exam?
Palpate head and neck, looking for skull or cervical injury
Palpate facial bones and periorbital, mandibular, and maxillary areas
Open/close mouth - assess for TMJ pain/mandible fracture
Inspect nose for deformities
Look for fluid from nose or ears
Performed detailed neuro assessment (visual fields, EOMs, pupillary reflexes)
Assess strength and sensation in extremities
Coordination and balance
** On sideline, should be repeated every 15 minutes until symptoms cleared
What general instructions should you give the parents after concussion?
Monitor child closely for the next 24 hours for any of the red flag signs and symptoms
Not usually necessary to wake the child from sleep unless the provider instructs them to do so
What are the return-to-play guidelines after concussion?
During game or activity:
No return to play if symptoms or exam do not return to normal after 15 minutes
For outpatient:
Must be completely asymptomatic for clearance (no headache, dizziness, amnesia, or cognitive issues)
Symptoms must resolve both at rest and with exertion before clearance is granted
When would you send a patient for imaging?
Focal neurological signs
Signs of increased cranial pressure
Low Glasgow Coma Scale
Seizures related to the trauma
How can a concussion be prevented?
Wear helmets when appropriate and be sure they fit properly
What are postconcussive syndrome symptoms that can last several weeks after the concussion?
Headache (most common) - treat w/non-narcotic analgesics and antiemetics Dizziness (second most common) Fatigue Irritability Impaired memory/concentration Lower tolerance for noise and light Insomnia
Why are children’s brains more prone to certain injuries from trauma?
Children’s brains have a higher water content and are softer, making them more prone to acceleration-deceleration injuries
Larger in proportion to body surface area
Stability depends on ligamentous structures rather than bony structures
Brain is unmyelinated in infants and young children making them more susceptible to shearing injuries
What is the difference between retrograde and antegrade amnesia?
Retrograde: can’t remember things from (before)
Antegrade: (after) can’t remember new things
If you decide to do imaging for a concussion, what would you order?
CT: quickly rule out a bleed
MRI: for patients with prolonged symptoms; can detect more subtle changes
