Sport Concussion Flashcards
Concussion
- aka
- what?
- time to resolution
aka= mild traumatic brain injury
what: direct blow(coup), countercoup, or rotational/acceleration injury, whip lash (MVA deceleration injury); changes in brain physiology rather than structural changes.
Resolution: usually takes 7-10days
Concussion pathophysiology
neuronal depolarization leading to release of excitatory NT; K+ efflux and Ca2+ influx.
Impairment of glucose metabolism, cerebral blood flow, and axonal function.
Concussion Dx
- Hx, Signs and Symptoms, exam findings, neurocognitive testing, balance testing
- imaging is usually normal so its not required
The presence of ____ is more predicitive of sx and neurocognitive deficits than ____.
presence of amnesia is more predictive of sx and neurocognitive deficits than LOC
Concussion signs and sx
sx:
- HA, confusion, foggy, may or may not involve LOC/amnesia, dizziness, tinnitus, inability to focus, memory dysfunction, inappropriate emotionality , double vision, nausea, difficulty falling asleep.
-vacant stare, poor coordination, unsteady gait, slow to answer/follow commands, poor concentration, slurred speech, personality changes, diminished ability or reckless playing behavior, seizure
Concussion evaluation: describe what is all done in the following:
- mental status testing
- gait/balance
Mental status:
- orientation q’s
- concentration (subtraction, months backwards)
- memory
Gait:
- walk normally
- tandem gait
- romberg
Concussion signs Demanding emergency action
-Increasing HA, nausea, vomiting
-progressive impairment of conciousness
-gradual rise in BP
-diminution of pulse rate
-blown pupil
-disorientation (worsening of mental status)
-suspicion for hematoma
-C-spine injury
-focal motor weakness
-transient quadriparesis
-seizure
-high risk of intracranial bleed
-
Concussion: signs of non-emergent referral to neurology
presisent HA greater than 7 days
post concussion syndrome lasting greater than 2 weeks
abnormal neuropsych testing
Hx of multiple high grade concussions
clinical judgement
Concussion can mimic what other disorders?
- substance abuse/dependency
- intermittent explosive disorder
- suicidal ideation/tendencies
- depression
- mood disorder
- impulse control
On field evaluation of concussion
- ABC’s first!!!
- any LOC treat as C-spine injury
- any signs of neurologic deficits, immediate transfer to ER
Sideline eval of concussion
Post-game eval of concussion
- check out signs and symptoms, mental status
- assess gait and balance
Post Gamee:
- similar to sideline
- should include take home instructions
- discuss status of athlete with parents and coaching staff
Young and adolescent Athletes w/ concussion
-how long until they can return to play?
-use a longer symptom-free period before starting exertion protocol b/c their symptom resolution may take longer.
Tx of Mild concussion
- rest, fluids. and good nutrition
- -sleep
- -no training, playing, exercise, chores
- -cognitive rest; no tv, video games, texting, music
-avoid NSAIDS for first 48hrs d/t increased bleeding (better to take tylenol)
When can players return to play post concussion?
- must be fully recovered, usually 7-10days.
- must pass exertional test w/o sx
- consider the rule of 3’s
1. one concussion= out of the game and practice for several days
2. 2 concussions = out for the season. :(
3. 3 concussions = out of the sport…forever. :( :(
Describe the progression for return of the EXERTIONAL TEST.
- recurrence of sx at any point drop back.
- aerobic exercise- light walking, biking
- sport specific activities w/o opponent
- non-contact drills
- full contact drills
- return to the game
