Lecture 10 - Head, Neck, & Face Injuries Flashcards
1
Q
What are the conditions of the head?
A
- injuries involving the head & neck can be the most severe because of the life-threatening aspect
- The brain upon which the body is total dependant can be easily damaged with the simplest of trauma
2
Q
What is a sport related concussion?
A
- may be caused by a direct blow to the head, face, neck or elsewhere in the body with an “impulse” (twisting or shearing force such as in whiplash) force transmitted to the head
3
Q
What are 2 types of concussion traumas? How do they happen?
A
- Direct Blow: causes focal damage to the brain: ex. Injury localized to the area hit by puck, baseball, stick, etc.
- Indirect: the outside force causes the mobile brain to to accelerate then decelerate & impact on the opposite side of the skull
4
Q
What are the results of a sport related concussion?
A
- rapid onset of short-lived impairment of neurological function that resolves spontaneously,in some cases, can evolve over several minutes to hours
- may result in neuropathological changes
- may or may not involve loss of consciousness. Resolution of the clinical & cognitive features typically follows a sequential course. in some cases symptoms may be prolonged
5
Q
What can happen if you suffer a concussion?
A
- Swelling (edema) of the brain
- Decreased blood flow to the brain
- Loss of the brain’s ability to auto regulate
- Changes in EEG activity
- Changes in higher cortical function such as impaired memory
- In a severe trauma, there may be bleeding & obvious damage to the brain structures
6
Q
What are 2 types of brain bleeds? What do they do?
A
- Epidural Bleeding: Blood clot or hematoma on top of the dura
- Subdural Bleeding: Blood clot or hematoma under the dura
7
Q
What are the signs & symptoms of a concussion?
A
- Momentary loss or prolonged loss of Consciousness, Disoriented (unaware of person, place, time), Dizziness, Headache, Nausea, Ringing in the ears (tinnitus), Blurred or double vision, Nystagmus ( involuntary eye movements), Poor balance, Incoherency /Slurred speech, Loss of coordination, Pain or numbness in the arms or legs
8
Q
What is the on field care of a head-injured athlete?
A
- ensure no immediate danger
- check responsiveness
- consider 911, call if unconscious. If unconscious, ensure airway is clear & they are breathing
- check vital signs
- head to toe scan
9
Q
How to evaluate for a concussion on field?
A
- athlete should lie still
- stabilize their head in position they’re found
- ask if there is any pain
- do not remove helmet if they have one on
- ask if they have numbness or tingle
- rule out neck injury, if not present, slowly get them up
10
Q
How to do an on field mental & well being assessment of a concussion?
A
- determine if they are oriented x 3, i.e., Person - who they are, Place - where they are, Time - am./pm.; day; month; year
- All questions you ask regarding mental
awareness should be the kind that requires the athlete to think: - Don’t ask them questions they can answer
“Yes” or “No” to - ask them to recall previous events (i.e., breakfast, the game)
11
Q
What is Anterograde Amnesia (Post-Traumatic Amensia)?
A
- loss of memory of events close to the time of the trauma & the time after
- person is basically unable to effectively use their short-term memory & process and store things in long-term memory
12
Q
How can you assess Anterograde Amnesia (Post-Traumatic Amensia)?
A
- ask the athlete to remember 3 to 5 words i.e. four, purple, alligators. Ask the athlete to repeat them back to you this tests their immediate recall
- then ask them again in 5 min. this tests their short-term memory capacity
13
Q
What to do when an athlete suffers a concussion?
A
- player should not be allowed to return
to play in the current practice or game - player should not be left alone, should
be assessed and continually monitored for
changes or deterioration - player should be evaluated by a qualified Medical Doctor or HCP
- return to play/participation must follow
a gradual process that is monitored
14
Q
What to do after suffering a concussion when at home?
A
keep an eye on the athlete for at least 24hrs
- Parents should be notified that their child has received a blow to the head
- check on their child every 1 ½ - 2 hrs. throughout the night to see if they are all
right - If the individual appears in distress & cannot be awakened, then an ambulance must be called
15
Q
How to return to sports following a concussion?
A
- 24–48 hours of both relative physical rest & cognitive rest is recommended before beginning the RTS progression
- Once asymptomatic, proceed to Step 1, &
continue to proceed to the next level if
asymptomatic - If symptoms reoccur, drop back to a step where there are no symptoms and try to progress again
16
Q
What are the 6 steps for returning to play after suffering a concussion?
A
- 1 - symptom limited activity (i.e., daily activities that do not provoke symptoms)
- 2 - light aerobic exercise (i.e., walking)
- 3 - sport specific exercise
- 4 - on field practice w / no contact
- 5 - full practice
- 6 - return to play
17
Q
What is second impact syndrome in concussions?
A
- a rare but usually fatal condition whereby even a seemingly mild blow to a previously concussed brain leads to massive brain swelling
18
Q
What is post concussion syndrome?
A
- may begin immediately after the injury or within several days
- symptoms may last for weeks or months before resolving
19
Q
What are the signs & symptoms of post concussion syndrome?
A
- Persistent headaches, Anxiety & irritability, Fatigue, Depression, Inability to concentrate, Impaired memory, Visual disturbances
20
Q
What are 4 ways to help prevent concussions?
A
- wear appropriate protective equipment
- ensure adequate physical fitness within the neck & core
- adhere to the rules of the sport (i.e., play fair & smart
- respect your opponent
21
Q
What are spinal injuries?
A
- Injuries to the vertebral column must be handled very carefully
- A neck or back injury can lead to paralysis, or death if the spinal cord is damaged
22
Q
What is the MOI of spinal injuries?
A
- Hyper-extension/flexion
- Hyper-rotation
- Whiplash motion
- Axial Loading
23
Q
What type of injuries occur with the spine?
A
- most involve sprains & strains of the associated ligaments, capsules & muscles
- They are relatively benign & do well with standard treatment
- If the spinal cord is damaged permanent paralysis may result & If damage occurs above C- 3 this will cause paralysis of the diaphragm which is incompatible with life
- C - 3, 4, 5 Keep the Diaphragm ALIVE
24
Q
How to manage spinal injuries if unconscious?
A
- if a spinal injury occurs they may be either conscious or unconscious.
- If unconscious call for an 911 immediately & perform the A-B-C’s of first aid (airway, breathing, circulation)
- Do not remove any equipment or move the athlete unless absolutely necessary
25
Q
How to manage spinal injuries in conscious?
A
- do not move the athlete or remove any equipment
- check for numbness or tingle, ask to wiggle fingers & toes, check for neck fracture
- keep athlete warm & comfortable to keep them calm
- if in doubt, always call 911
26
Q
What is a mandible fracture?
A
- a break in the mandible bone
- occur most frequently in collision sports
- The most common site of injury is anterior to the angle
27
Q
What are the signs & symptoms of a mandible fracture?
A
- Acute pain on palpation & with movement
- Deformity
- Loss of normal occlusion
- Bleeding around gums & possible tooth
damage
28
Q
What is the treatment of a mandible fracture?
A
- Ice, Support & Medical Referral
- fracture will require reduction & approx. 6 weeks to recover.
- Prev. on return to activity. Proper headgear & mouth guard
29
Q
What is a mandibular dislocation?
A
- most frequently at the TMJ where the mandibular condyle gets forced out of the fossa
- caused by a direct blow to the jaw from the side when the mouth is open
30
Q
What are the signs & symptoms of a mandibular dislocation?
A
- jaw locked open & cannot move
- overriding malocclusion
- high potential for TMJ problems
31
Q
What is the treatment of a mandibular fracture?
A
- ice, medical referral, & rest 7-10 days before returning to activity
32
Q
What is the MOI of a nasal fracture?
A
- Direct blow resulting in a separated cartilage or broken bone or both
- may also be damage to the orbital floor
33
Q
What are the signs & symptoms of a nasal fracture?
A
- profuse bleeding
- may be lateral deviation of the septum
34
Q
What is the treatment of a nasal fracture?
A
- pinch nostrils to control bleeding
- ICE to control pain & swelling
- Medical referral to ensure proper reduction
35
Q
What is the MOI of epistaxis?
A
- also known as a bleeding nose
- caused by a direct blow, sinus infection, dry nasal membranes, or foreign bodies
36
Q
What is the treatment of epistaxis (bleeding nose)?
A
- pinch nostrils to control bleeding; wear latex gloves if you have to be in contact with the blood
- they are not to let go for a minimum of 5 min
- do not lean the head backwards as bleeding will go down the throat
- seek medical if bleeding lasts past 10 mins
37
Q
What are the components of the teeth?
A
a composite of mineral salts mostly calcium & phosphorus
- The Crown is the part above the gum & is
covered by the hardest substance in the body the Enamel - The root is below the gum & into the
alveolar fossa of the jaw. It is covered by a
substance called Cementum - Dentin makes up the bulk of the tooth & located below the enamel & cementum
38
Q
What is the MOI of a tooth injury?
A
- results of a direct blow to the teeth, or indirect, via a blow to the jaw
39
Q
What is a tooth dislocation?
A
- a tooth that is avulsed from its socket can usually be saved if prompt action is taken
- the periodontal ligament that holds the
tooth to the socket is ruptured & a portion remains on the root & a portion on the socket - The portion on the socket remains viable as it is bathed in the saliva & blood
40
Q
How to treat a dislocated tooth?
A
- keep patient calm
- pick up tooth by crown; avoid touching the root
- if dirty, wash briefly under cold water
- try to have patient replant it
- can bite on gauze to hold its position
- if not possible, place in a suitable storage
41
Q
What is a tooth fracture?
A
- If the crown is damaged there is little chance of saving it & usually requires being
capped - A fracture below the gum line may be
restored if the pulp has not been damaged - if the tooth fracture exposes the
underlying nerve it may cause a great deal of pain to the athlete
42
Q
What is the treatment of a tooth fracture?
A
- place a gauze pad soaked in oil of cloves over the tooth
- cover with skin lube or Vaseline
- apply commercially available anesthetic ointment
- Prevention: the use of properly fitted mouth guards
43
Q
What are face lacerations ?
A
- most often occur in the areas with underlying boney prominences such as over the eye, & the zygomatic process
44
Q
What is the treatment of face lacerations?
A
- control the bleeding with direct pressure following universal precautions (i.e., wear latex or appropriate gloves)
- Butterfly bandages or steri- strips can be used to temporarily seal the wound
- Seek out medical care for these wounds to ensure good cosmetic healing
45
Q
What are eye injuries?
A
- considered as severe until ruled out otherwise & treated carefully to avoid any compromise to vision
46
Q
What is an eye contusion?
A
- caused by a direct blow to the tissue surrounding the eye
- Swelling can be quite severe as is often seen in boxing where the eye lids can swell to close the eye shut
- The mechanism can easily cause an orbital fracture so this must be ruled out
47
Q
What is the treatment of an eye contusion?
A
- cold compresses
48
Q
What is a corneal abrasion?
A
- results from direct contact with the cornea by a finger, stick or projectile
- The injury can be very painful & may be increasingly sensitive to light
- The actual area of damage is found using fluorescein dye which will outline the injured area by staining it yellow
49
Q
What is the treatment of a corneal abrasion?
A
- eye patch to protect against further insult to the eye
- antibiotics to prevent infection
