Exam 1: Head Injury

Question 1

For a coo injury, where is the injury located?

Answer 1

The injury is direct at the point of contact

Compressive forces

Question 2

For a counter coo injury, where is the injury located?

Answer 2

The injury is opposite from the point of initial direct contact
(Tensile forces)

Question 3

What assessment/question will allow you to determine the severity of a head injury?

Answer 3

Length of amnesia

Question 4

What is a concussion?

Answer 4

A trauma-induced alteration in mental status that may or may not involve a loss of consciousness.

Question 5

T/F: The increased participation in organized sports has increased concussion rates.

Answer 5

False: Concussion rates have dramatically increased even though participation in organized sports has decreased.

Question 6

Do concussion rates increase during practices or games?

Answer 6

Concussion rates increase during games with the exception of volleyball. Concussion rates with volleyball increases during practices.

Question 7

Which sports have the highest risk for concussions?

Answer 7

Boys: football and hockey
Girls: soccer and basketball

Question 8

Overall, what are the major causes of concussion in children of all ages?

Answer 8

MVA
Falls
Child abuse (especially if < 2 yo)
Recreational activities especially in the spring and summer (especially ages 10-14)

Question 9

What are the signs and symptoms of concussion?

Answer 9

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

Question 10

T/F: Alcohol can mask the signs and symptoms of concussion?

Answer 10

True

Also rule out hypoglycemia, drug overdose, hyperthermia, or arrhythmia

Question 11

What are red flags to look for in concussion?

Answer 11

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

Question 12

Which signs/symptoms would indicate elevated intracranial pressure?

Answer 12

Persistent vomiting
Worsening headache
Increasing disorientation
Changing LOC

Question 13

When assessing for concussion, what will you want to do on the physical exam?

Answer 13

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

Question 14

What general instructions should you give the parents after concussion?

Answer 14

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

Question 15

What are the return-to-play guidelines after concussion?

Answer 15

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

Question 16

When would you send a patient for imaging?

Answer 16

Focal neurological signs
Signs of increased cranial pressure
Low Glasgow Coma Scale
Seizures related to the trauma

Question 17

How can a concussion be prevented?

Answer 17

Wear helmets when appropriate and be sure they fit properly

Question 18

What are postconcussive syndrome symptoms that can last several weeks after the concussion?

Answer 18

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

Question 19

Why are children’s brains more prone to certain injuries from trauma?

Answer 19

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

Question 20

What is the difference between retrograde and antegrade amnesia?

Answer 20

Retrograde: can’t remember things from (before)
Antegrade: (after) can’t remember new things

Question 21

If you decide to do imaging for a concussion, what would you order?

Answer 21

CT: quickly rule out a bleed
MRI: for patients with prolonged symptoms; can detect more subtle changes