Week 9 Flashcards
Injuries of the head, face and throat
- pharynx
- larynx
- trachea
- esophagus
- sternocleidomastoid
Larynx
- voice box
- connects throat to trachea
- prevents food from getting into trachea while breathing
Trachea
- brings air from throat to lungs
Esophagus
- brings food from throat to stomach
Relevant arteries, veins and nerves
- carotid artery
- jugular vein
- subclavian artery and vein
- vagus nerve
Bones of the face
- frontal bone
- orbital bones
- nasal bone
- zygomatic bones
- maxilla
- mandible
Bones of the head and face
- frontal bone
- parietal bones
- temporal bones
- occipital bone
- temporomandibular joint
Temporomandibular joint
- hinge joint btwn temporal bone and mandible
- articular disc within joint
Muscles that act on the TMJ
- temporalis
- pterygoids (medial and lateral)
- masseter
Injuries to anterior neck MOI
- blunt force to anterior neck/throat by stick, puck, ball, opponent
What sports are injuries to the anterior neck common in?
- field hockey
- hockey
- lacrosse
Signs and symptoms of injuries to the anterior neck
- pressure
- difficulty swallowing (feels thick)
- difficulty breathing
- panicky
What is there a risk of with injuries to the anterior neck?
- larynx fracture
Major bleeds MOI
- skate, stick, contact with boards leading to a laceration of carotid artery, jugular vein, subclavian vein
Acute management of major bleeds
- pressure
- rapid call to EMS
- treat for shock
- vascular surgical team to repair damaged vessels
Prevention of major bleeds
- neck guards
Neck guard mandates
- in place for junior leagues
- no mandate in NHL
- imp to find out policies for leagues you are working with
What are the different facial injuries?
- eye-poke injuries
- fractures
- auricular hematomas
- lacerations
- TMJ conditions
- dental injuries
What does eye-poke injuries commonly result in?
- subconjunctival hemorrhage
- corneal abrasion
Subconjunctival hemorrhage
- bright red bleeding/spot on white of eye from broken blood vessel
Corneal abrasion
- scratch on surface of eye
Signs and symptoms of eye-poke injuries
- mild discomfort
- irritation
Acute management of eye-poke injuries
- cold compress
- refer for eye exam
When should you refer for an eye poke injury?
- vision changes
- shadows
- floaters
- pressure
- pain
What serious conditions are you at risk for with an eye-poke injury?
- retinal tears/detachment
- deeper damage to eye/vessels
Facial fractures MOI
- direct trauma via opponent, puck, ball
What sports are facial fractures common in?
- hockey
- football
- rugby
- baseball
Which types of facial fractures are most common?
- zygomatic-maxillary-orbital
- isolated mandibular
- nasal fractures
Signs and symptoms of facial fractures
- TOP fracture site
- racoon eyes
- swelling
- divots
- deformities
Acute management of facial fractures
- PIER
- refer
Auricular hematoma MOI
- blunt trauma
- repetitive friction
Signs and symptoms of auricular hematoma
- pain
- swelling
- bruising
What can an auricular hematoma lead to?
- blood accumulates btwn connective tissue and cartilage of ear = increased pressure
- can lead to necrosis of cartilage from blood supply being cut off
Cauliflower ear
- aka wrestler’s ear
- results if blood is not drained resulting in cartilage becoming deformed
What sports is auricular hematoma common in?
- wrestling
- boxing
- judo
Acute management of auricular hematoma
- PIER
- add pressure by packing ear with folded gauze to prevent fluid accumulation and maybe magnets
Lacerations (facial injury) MOI
- blunt trauma
- sharp object
How to handle lacerations of the face
- refer for stitches
Acute care of lacerations to the face
- pressure
- steri-strips
TMJ conditions MOI
- direct trauma to mandible
- cumulative repeat impacts
Which sports are TMJ conditions most common?
- contact sports
What can TMJ conditions result in?
- dislocations
- fractures
- sprains
- articular disc injuries
- muscle tension/strains
- clicking/altered joint mechanics
- headaches
Dental injuries MOI
- direct blow
Common sports related dental injuries
- tooth (crown) fractures
- tooth intrusion
- tooth extrusion
- tooth avulsion
Tooth intrusion
- tooth gets forced into the bone
Tooth extrusion
- tooth gets forces out of the bone
Tooth avulsion
- complete removal from socket
Acute management of dental injuries
- ensure broken teeth removed from mouth
- rule out concussion & C-spine
- refer to dentist
- ER
- rolled gauze to control bleeding
- on-field Dr. can supply numbing agent
Prevention of dental injuries
- mouthguards
Types of headaches seen in sport
- dehydration
- cervicogenic
- concussion
What percentage of headaches are dehydration headaches?
- 90%
Cervicogenic headaches
- muscle tension
- joint dysfunction
Concussions (mild traumatic brain injuries) MOI
- direct or indirect blow
What type of injury are concussions?
- functional injury but physical damage needs to be ruled out
- transient change of neurological function
Cause of concussions
- stretch and shearing of axons
- stretch, ion exchange, depolarization of action potentials
- results in an electrical storm
Signs of concussion
- vomiting
- disorientation
- memory loss
- loss of consciousness
Symptoms of concussion
- headache, pressure, migraines
- cognitive changes
- vestibular system changes
- nausea
- fatigue
- fogginess
- mood changes
Symptoms of concussion- cognitive changes
- decreased focus and thought processing
- difficulty following instructions/directions
Symptoms of concussion- vestibular system changes
- dizziness
- motion sensitivity
- decreased balance & coordination
Symptoms of concussion- mood changes
- anxiety
- depression
- irritability
What injury is often missed with a concussion?
- c-spine injuries
- can contribute to symptoms
What does assessing a concussion include?
- interviews
- physical exams
- testing
Two common assessment tools
- SCAT6 - sport concussion assessment tool
- ImPACT testing (immediate post-concussion assessment and cognitive testing)
SCAT6
- standardized tool for evaluating concussions
- sideline and clinical
- designed for health care professionals
- takes 10-15 min to be done exactly
ImPACT Testing
- computerized objective tool (clinical only)
- requires baseline test
- measures memory, attention span, visual & verbal problem solving
Components of concussion assessment SCAT6- immediate assessment/neuro scan (on-field)
- Observable signs
- Glasgow Coma scale (LOC)
- Cervical spine assessment
- Coordination & ocular/motor screen (visual, vestibular)
- Memory assessment maddocks questions (cognitive)
Components of SCAT6 - immediate assessment: observable signs
- athlete position
- athlete behaviour
- MOI
Components of SCAT6 - immediate assessment: Glasgow coma scale
- eye
- verbal
- motor responses
Components of SCAT6 - immediate assessment: cervical spine assessment
- pain at rest
- TOP
- AROM
- limbs
Components of SCAT6 - immediate assessment: coordination & ocular/motor screen
- finger to nose
- follow finger
Components of SCAT6 - immediate assessment: memory assessment maddocks questions
- questions re venue
- game
- past games
Components of concussion assessment SCAT6- Off field assessment
- Athlete background
- Symptom evaluation
- Cognitive screening
- Coordination & balance examination
- Delayed recall
- Decision
Components of concussion assessment SCAT6- Off field assessment: cognitive screening
a) orientation
b) immediate memory
c) concentration
Post-concussion syndrome
Timeframes vary
- >3 months
- >4 weeks
- >7-10 days post injury
Concussion testing and rehabilitation tools
- helps to zero in on the primary issues limiting recovery
- which system is exacerbating systems
- focuses on establishing functional neural pathways in the brain to support complete recovery
Which systems could be exacerbating concussion symptoms?
- visual
- vestibular
- physiologic
- cervicogenic
- psychological
What is no longer the recommendation for concussions?
- complete rest with no stimulation
What is chronic traumatic encephalopathy (CTE)
- progressive degenerative brain disorder caused by repeat head injuries
Signs and symptoms of chronic traumatic encephalopathy
- memory loss
- confusion
- headaches
- irritable mood
- aggression
- depression
- slurred speech
- unsteady/altered motor control
Concussion injury prevention
- mouthguards
- proper helmet fitting
- safe technique
- concussion education
What does concussion education include?
- early identification
- No RTP with even 1 symptom
- safe & progressive RTP
