Download Head Injuries

Introduction
The term “head injury” can be
used to describe damage to the
scalp, cranium, or brain.
Any injury to the head or
spine is a serious matter due to
possible brain hemorrhage.
The head can be divided into
two anatomical groups: the
face and the cranium.
Face – eyes, ears, nose, jaw,
and mouth.
Cranium – brain and spinal
cord attachments.
Head and Spinal Injuries
Sports that carry a higher risk of head/neck
injuries:
Gymnastics
Ice Hockey
Basketball
Football
Diving
Extreme Sports
https://www.youtube.com/watch?v=UKZ6yQA1SLw
Anatomy of the Head
The “Head” is comprised of the cranium and the face.
The head contains several of the special sensory organs
such as the eyes, ears, nose, and mouth (sight, sound, smell,
and taste.
Cranium = The cranium is a collection of bones fused
together to protect the brain.
8 Bones
Face = The anterior portion of the head. Comprised of the
Eyes, Ears, Nose, Jaw, and Mouth.
14 Facial Bones
Anatomy of the Cranium
Occipital
Parietal (2)
Frontal
Temporal (2)
Sphenoid
Ethmoid
Housed within the cranium are the brain and the primary
neural tissues of the Central Nervous System (CNS) that
send vital nerve impulses to and from the brain.
CNS = the body system composed of the brain and the
spinal cord.
Anatomy of the Cranium
Anatomy of the Face
Mandible
Maxilla (2)
Zygomatic (2)
Nasal Bones (2)
Lacrimal Bones(2)
Vomer
Palatine (2)
Inferior Nasal Conchae (2)
Joints of the Cranium
Except for the
mandible, the bones
of the cranium
articulate with one
another via
immovable joints,
called sutures.
The
temporomandibular
joints (TMJ), which
are freely movable,
join the mandible
with the temporal
bones.
https://www.youtube.com/watch?v=0CfZkIVNw7M
The Nervous System
The main components:
Brain, cranial nerves, spinal cord, spinal nerves, and peripheral
nerves.
Main function is to coordinate and regulate the body’s many
responses to internal and/or external environmental changes.
The basic structural unit of the nervous system is the nerve cell, or
neuron (neurons differ from common cells in their design and
specific function).
Two types of neurons – sensory (afferent) and motor (efferent).
Example: If a person touches a hot surface, the sensory neurons
will detect heat, and the motor neurons will cause the body to
remove the hand away from the heat source.
Nervous System Divisions
Central Nervous System (CNS)
Peripheral Nervous System (PNS)
Central Nervous System
CNS: consists of the brain and the spinal cord.
The Brain: located within the cranium and performs numerous functions,
primarily controlling and coordinating the body’s activities.
Parts of the Brain include:
Cerebrum – controls willful actions; interprets sensory messages gained
from sound, sight, smell, touch, and taste; and governs thought and speech.
Cerebellum – responsible for muscle coordination.
Midbrain – conducts impulses throughout the brain and certain visual and
auditory reflexes.
Pons – responsible for some reflexive actions, such as chewing and
salivation.
Medulla oblongata – controls involuntary actions such as respiration,
heartbeat, blood pressure, swallowing, and coughing.
Central Nervous System
The Spinal Cord:
Attached to the medulla oblongata of the brain and continues
down to the first or second lumbar vertebrae.
Protected by the vertebrae, cerebrospinal fluid, and meninges.
Serves as a pathway for messages.
Two Main Functions:
Conduct impulses through nerves
Connect body parts to the brain
If the spinal cord is damaged in an accident, the sections below the injury
will be cut off from the circuit of information to and from your brain. This
means, all nerves, and all body parts linked to these areas of the spinal cord
will also be disconnected from the brain and will stop functioning.
The Spinal Cord
Peripheral Nervous System
Outside the CNS
Responsible for gathering information and carrying the
response signals to and from the CNS.
Composed of the nerves located outside the brain and
the spinal cord.
Two Divisions:
Somatic – Controls skeletal muscles for voluntary
movement.
Autonomic – Involuntary functions of the body (“fight
or flight”) and maintains homeostasis.
Head & Spinal Injuries
Any injury to the head
or spine is very serious.
A spinal cord injury:
A head trauma:
Can cause brain
hemorrhage (bleeding
in the brain).
Can fracture the
skull.
Can send a fragment
of the skull into the
brain.
The spinal cord serves as
the communication
pathway between the
brain and the rest of the
body.
Can be life threatening
and can cause paralysis.
Concussion Facts
Most common head injury
in athletics.
Fewer than 10 percent result
in loss of consciousness
(LOC).
In football alone there are
over 250,000 concussions
each year.
Once a concussion has
occurred a player is 4 to 6
times more likely to sustain a
second concussion.
What is a Concussion?
Cerebral Concussions: Temporary
alteration in brain function
without structural damage.
Injury to the brain, accompanied
by loss of neural function.
Frequently caused by blows to
the head or sudden jerks of the
head and neck.
Different degrees of concussions
present with different symptoms.
Second-impact syndrome: a second
concussion before the S&S of the
first concussion have been
resolved; a life-threatening
emergency.
https://www.youtube.com/watch?v=Sno_0J
d8GuA
Mechanism of Injury of
Concussions
Coup – results when a relatively
stationary skull is hit by an object
traveling at high velocity.
Example – being struck in the
head with a baseball
Results in trauma on the side of
the head that was struck.
Countrecoup – when the skull is
moving at relatively high velocity
and is suddenly stopped.
Example – falling and striking the
head on the floor.
Causes the brain to strike the skull
on the side opposite of the impact
Mechanism of Injury of
Concussions
S&S of Concussions
LOC
Loss of coordination
Disorientation
Slurred or incoherent speech
Headache
Irritability
Dizziness
Anxiety
Nausea/Vomiting
Depression
Poor concentration
Tinnitus – ringing in the ears
Posttraumatic amnesia
Vacant stare
Retrograde – no memory of
events that occurred before the
injury
Anterograde – no memory of
being injured or immediately
following the injury
Pupils not reacting evenly to light
or unresponsive
Athlete may experience one or more
S&S and have a concussion!
Classification of Concussions
Categorized by severity.
Guidelines for concussion severity have been created by several
organizations, therefore differ.
Concussion Grade
CANTU Grading System
Grade 1 (Mild)
• No LOC
• Either PTA (Posttraumatic amnesia) or
postconcussion symptoms that clear in
less than 30 minutes
Grade 2 (Moderate)
• LOC lasting less than 1 minute and PTA
or
• Postconcussion signs or symptoms
lasting longer than 30 minutes but less
than 24 hours
Grade 3 (Severe)
• LOC lasting more than 1 minute or
• PTA lasting longer than 24 hours or
• Postconcussion signs or symptoms
lasting longer than 7 days
Treatment of Concussions
When an athlete shows any S&S of a concussion:
The player should not be allowed to RTP (return to play) in the
current game or practice.
The player should not be left alone; regular monitoring for
deterioration is important.
The player should be medially evaluated following the injury.
RTP must follow a medically supervised, stepwise process.
Postconcussion Syndrome
Condition that can develop following a mild or severe
concussion.
S&S:
Persistent headache
Impaired memory
Inability to concentrate
Anxiety and irritability
Fatigue
Depression
Visual Disturbances
Second Impact Syndrome
Rapid swelling of the brain after a 2nd head injury occurs
before the symptoms of the previous head injury have
resolved.
The second impact may be minor, or may even not involve
impact to the head – A blow to the chest or back may create
enough force to move the athlete’s head suddenly.
Rapid deterioration of condition – LOC, dilated pupils, loss
of eye movement, respiratory failure.
50% mortality rate.
PREVENTION!! Do NOT allow an athlete who is
symptomatic to RTP!
Prevention
Maintaining flexibility and strength of the neck
musculature.
Properly fitted protective gear - shoulder pads, helmets,
face masks.
Following safety rules of the game – no helmet to
helmet contact or leading with the head in football.
Concussion Evaluation
History
Mechanism – How did it
happen?
Chief Complaint
Previous History
Recovery time for previous
concussions
Mental Confusion
Weakness in Limbs
Abnormal Drowsiness or
Sleepiness
Loss of Appetite
Headache
Difficulty Concentrating
Neck or Cervical Pain
Tinnitus = ringing in the
ears
Location and Type of pain
Pain level (Scale of 1-10)
Diplopia = double vision
Concussion Evaluation
History Continued
Numbness,
Tingling, or Loss
of Sensation
Dizziness or
Lightheadedness
Photophobia =
sensitivity to
light
Nausea or
Vomiting
Concussion Evaluation
Cognitive Questions
Orientation Questions
Where are you? What school/stadium/field?
What month is it? What team are you playing?
What is the score?
Post Traumatic Amnesia
Ask athlete to repeat and remember 3 words.
Retrograde Amnesia
Do you remember the injury?
Concentration
Say the days of the week backwards.
Word List Memory
Ask athlete to recall the 3 words from earlier.
Concussion Evaluation
Observation
Level or Loss of Consciousness
Poor Balance or Unsteadiness
Gross Incoordination
Seizures, Convulsions, Vomiting
Slurred Speech
Asphasia = inability to speak
Respiration Rate
Unusual Behavior or Heightened
Emotions
Swelling, Deformity,
Discoloration, Bleeding
Fluid discharge
Otorrhea or Rhinorrhea
Battle Sign (Mastoid
Ecchymosis)
Raccoon eyes
Pupils –
Size (Anisocoria – Unequal)
Reaction to Light (PEARL)
Tracking (Nystagmus – inability
to track smoothly)
Vitals
Palpation
Mastoid Process
Maxilla
Temporal Bones
Orbit
Occipital Bones
Sphenoid Bones
Parietal Bones
Frontal Bones
Front Sinus
Zygomatic Bones
Nasal Bone
Mandible
TMJ
C2 – C7
Vertebrae
Special Tests
1. Balance & Coordination
2. Cognitive Thinking
3. Neurological
Concussion Evaluation
Coordination
Index finger to nose
Index finger to index
finger
Rhomberg test
Tandem walking
Rhomberg Test
Patient Position: Instruct the athlete to stand with feet
shoulder width apart.
Examiner Position: The examiner should stand lateral
to the patient ready to support them if needed.
Procedure: The athlete shuts their eyes and abducts
their arms to 90 degrees with the elbows extended.
Then tilts the head backward and lifts one foot off the
ground while attempting to maintain balance.
Positive Sign: Gross unsteadiness
Tandem Walking
Patient Position: Standing with feet straddling a
straight line.
Examiner Position: Beside the patient ready to provide
support.
Exam Procedure: The patient walks heel to toe along
the straight line for approximately 10 yards. Then the
patient returns to their starting position by walking
backwards.
Positive Sign: Unable to maintain a steady balance.
Retired NFL Players:
Nearly 9 in 10 suffer aches and
pains daily.
91% connect nearly all their
pains to football.
9 in 10 are happy they played
football, but fewer than half
recommend their children play.
9 in 10 report suffering
concussions.
Nearly 6 in 10 report 3 or more
concussions.
2 in 3 experience continuing
symptoms from concussions.
https://www.youtube.com/watch?v=F4foY1EtmKo
http://espn.go.com/video/clip?id=8574507 https://www.youtube.com/watch?v=wb6B
5skuBA
http://espn.go.com/video/clip?id=5453050
Project - Concussion PSA
Create a concussion PSA to raise awareness of the
importance of reporting a head injury!