Final - Concussions Flashcards
concussion
sport related concussion is a traumatic brain injury induced by biomechanical forces
pathophysiology
increase in neuronal depolarization - decrease K and increase Ca
increase Na K pump so you need more ATP and increased glucose metabolism
hypermetabolism decreases cerebral blood flow and increase glucose demand
depressed metabolism warrants unchecked Ca accumulation and can lead to cell death
neurochemical changes in brain after concussion
will correct on its own within 2-4 days but repeated will not
impairments of neurological function
rapid onset and short lived for minutes to days - can be up to 5 days until it comes out
CT and concussion?
no - functional not structural unless its a bleed
loss of consciousness and concussion
not a lot so dont get reported - less than 2 mins has no bearing of severity but more than 2 is more complex and CT is warranted
how to identify a concusion
obersvation of event and B after
when in doubt
sit them out for 24 hours for slightest suspicion and y days if one is diagnosed
scat 5
5th symposium
sideline assessment and most tested/validated and quick and cheap stand alone tool - health care providers
most effective within first few days - longer the less valid
not sole diagnostic but an aid
standard for 13 and up
child for less than 12 yr - gen maturity
3 red flags
vomitting
staggering
slurred speech
6 observable signs
witnessed motionless - wind? thoughts? balance/gait confusion/inappropriate responses blank/vacant stares facial injuries
maddocks
appropriated to environment and make it a convo
- venue
- half of game
- who scored last
- team played last week
- did you win last game?
glasgow coma scale
best eye response
best verbal response
best motor
15/15 decrease and call an ambulance
cervical spine assessment - 3
clear midline neck pain first
AROM
limb strength and sensation
symptom score
fill out on their own and watch them
- more honest and fine motor functioning and focus, redo symptoms every time you see them
athlete background - age, gender, ed lvl, concussion hx, confounding things
26 symptoms 0-6
cognitive testing
orientation - month, day, year, time
immediate mem - 5-10 unrelated words 3 times and repeat
digits backwards - increasing length
months in reverse order
neurological screen
read out loud
PROM cervical
smooth tracking with no double vision
coordination of hand to nose
tandem gait - 10 m - eyes closed if needed
balance - double, single, non dominant, tandem, eyes closed, softer surface, turn your head - only count big errors
delayed recalled
what were the 5/10 words i gave you?
decision
scores from tests, and clinical judgment - when you decide to do a scat, the decision has been made that you are not going back - 24 hours
tough on concussion guidelines
parachute canada and rugby
no red flags?
no ER
initial rest - 4
`alcohol, med (can be given from med professionals and med supervisions and they are resting , but we weant to know your symptoms), driving, PA
treatment
detailed assessment - history, cognitive exam, visual and vestibular testing, cervical examination, other as warranted - physical exertiaonal, coordinaton - then do these while PA
treatment plan
individualized
complete vs relative rest
24-48 hrs decrease stim and sleep as much as you want - anxiety can mess up things and fck with the chemicals
after 48 do as much as you can as long as you dont increase symptoms - or your brain gets good at doing nothing
sleep hygiene
after 48 go back to typical sleep pattern - bed and wake up at the same time
mental health
tell them the recovery rates
academic and work
up to ind
early interventions
good - PA after 48 hours 2 20 min walks a day
treatmnet
cervical, visual, vestibular, cognitive, physiologic, anxiety, migraine - likely to express after concussion when in the family
return to learn
have a convo - ASAP, breaks as needed, modified days, options on individualized basis, tolerate testing and hw - dont miss school becasue that makes them more anxious
return to sport
school/work first stage not days must be symptom free stage before progress cant have 2 stages in 24 hours sport specific
5 stages of returning to sport
light exertional - 20 min bike mod exertional - 20 min jog sport specific drill full practice without contact full practice with contact return to sport
time line for return to play
min 7 days 2 rest and 5 RTP
recovery
75-85% recover in less than 2 wks, kids 4 wks, 2% that dont recover on their own and have symptoms that go above a year
second impact syndrome
sequential concussive blow while experiencing symptoms from prev acute metabolic response 4 days most critical long term brain damage possible <21 greater chance of sudden death
baseline testing
does not change treatment <18 not recommended >18 limited clearing confounders and good hx can play some role in prevention - migraine anxiety and depression learning disability cervical muscle weakness motion sickness impaired visual perception
the 3 cs
cerebral - orientation, concentration, mem
cerebellar - balance and motor
cranial nerves - neurological functioning
cerebral main signs
LOC intellectual emotional though content sensory language
cognitive tests
effect of head injury on cognitive function - status and improvement - serial 7s, months in reverse order
how to test for optic nerve
blurred vision - read close up and far away - cerebral injury
rhomberg test
static - normal sway
eye closed and hands at side
one foot, tandem, soft surface
coordination - 4
finger to nose
tandem walk
standing heel to knee
physical exertion - side line RTP
go through the whole thing and wait 15 mins if they only have bad balance, then ask in private if they want to go back sports specific pushup situp bear crawl burpies
how many days for all your symptoms to go away?
21
when to stop on stationary bike on day 1
when you feel bad
