sports medicine head injuries. daily objectives content objectives learn the anatomy of the...
TRANSCRIPT
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SPORTS MEDICINE
Head Injuries
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Daily Objectives
Content Objectives Learn the anatomy of the cranium and brain. Gain an understanding of the dangers
involved with head injuries. Language Objectives
Copy notes off of power point. Complete reading assignment.
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Pace Lap
Why are head injuries so dangerous? 4 minutes
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Head Injury Facts
Any injury to the scalp, cranium, or brain.
Can occur in any sport.Caused by the application of a sudden force.
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Assignment
Please read page 531 and 532 label the cranium diagram and answer the following question. What two anatomical groups can we divide the head
into?1. Face
1. Eyes2. Ears3. Nose4. Jaw5. Mouth
2. Cranium1. Brain2. Spinal Cord
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Anatomy of the Skull
Oblong, egg shaped collection of bones that is designed to protect the brain.
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The Skull (Cranium)
Frontal Bone Anterior bone that
makes up the forehead. Very Strong
Temporal Bone Bone that makes up
the sides of the skull along the temples. Much weaker and more susceptible to fracture.
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The Skull (Cranium)
Occipital Bone The most posterior
bone of the skull. Foramen Magnum: A
big hole in the occipital bone that allows the spinal cord to pass through.
http://faculty.washington.edu/chudler/skull.html
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The Skull (Cranium)
Parietal Bone The largest of
the bones of the skull.
Protects the largest part of the brain.
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Reading Assignment
Read pages 561- 562 and answer the following questions.1. What are the three parts of the
brain?2. Define the three parts of the
brain.3. What are the three meninges?4. Define the three meninges.
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The Brain
Three Parts Brainstem Cerebellum Cerebrum
http://health.allrefer.com/pictures-images/lobes-of-the-brain.html
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Brainstem
Brainstem Lowest part of the brain that merges with
the spinal cord. Functions controlled in the brainstem
include: Breathing Heart Rate Blood Pressure Arousal (Awake and Alert) Digestion
http://health.allrefer.com/pictures-images/lobes-of-the-brain.html
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Cerebellum
Cerebellum Part of the brain that controls muscular
coordination and complex movements. Also known as:
Athletic BrainLittle Brain
http://health.allrefer.com/pictures-images/lobes-of-the-brain.html
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Cerebrum
Cerebrum The largest and most highly evolved part of
the brain. Divided into a right and left hemisphere. Divided into four different lobes.
Frontal Lobe Temporal Lobe Parietal Lobe Occipital Lobe
http://health.allrefer.com/pictures-images/lobes-of-the-brain.html
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Lobes of the Cerebrum
Frontal Lobe Speech Higher Intellectual Functioning
Temporal Lobe Hearing Memory Speech Perception
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Lobes of the Cerebrum
Parietal Lobe Somatic Sensory
Occipital Lobe Auditory Vision Visual Perception
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Meninges
Protective membranes that surround the brain and spinal cord.
Dura Mater The outermost membrane that lies just beneath the skull
and covers the brain and spinal cord. Arachnoid
The membrane that lies beneath the dura mater. It is web like and covers the entire brain and spinal cord.
Subarachnoid space: Space between the arachnoid and the pia mater.
Pia Mater The innermost membrane that directly covers the spinal
cord and brain.
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The Meninges
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Pace Lap
What are the four lobes of the brain? 4 minutes
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Background Info
½ of the trauma related deaths in the US are due to head injuries.
The mortality rate after a sever head injury is approximately 35%.
Three categories of Head Injuries1. Scalp Injuries2. Skull Fractures3. Brain Injuries
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Scalp Injuries
Contusions and Lacerations are most common.
Key Question Does a scalp injury indicate an injury to
the skull or brain? No, they may or may not involve skull and
brain injuries. You can have an observable scalp injury
and no brain injury You may not have an observable scalp
injury, but have a severe brain and skull injury.
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Signs and Symptoms of a Scalp Injury
Profuse bleeding. Swelling Tenderness Hematoma
(Goose Egg)
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Treatment and Rehabilitation for Scalp Injuries
Locate and control bleeding with direct pressure.
The neurologist or physician should decide when the athlete should return to play.
Apply ice if there is no bleeding.
Refer to the nearest emergency facility when necessary.
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Reading Assignment
Read the section titled “Skull Fractures” on page 564 and answer the following questions. What are some causes of a skull fracture? What are some signs and symptoms of a
skull fracture? What is the best treatment for a skull
fracture? Who may decide when the athlete can
return to play?
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Skull Fracture
Not common in athletics Can be a simple fracture. Can be a compound/depressed fracture
These are more dangerous because the skull fragments can lacerate brain tissue.
Causes Direct blow to an unprotected head.
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Skull Fractures
Signs and Symptoms Bleeding or Cerebrospinal fluid (CSF) that drains
from the ear or nose. Obvious deformity. Point tender upon palpation.
Treatment and Rehabilitation Immobilization and EMS. Treat for shock. Control Bleeding Return to play dictated by physician. Added protection when returning to play.
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Pace Lap
Is the inside of the skull smooth or rough? How does this answer effect the brain? 4 minutes
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Reading Assignment
Read page 564-565 regarding brain injuries and answer the following questions:1. What is the difference between a cerebral
concussion and a cerebral contusion?2. What is a contrecoup injury?3. What determines the severity of the brain
injury?4. True or False: A brain injury is a result of a
single blow to the head.
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Brain Injuries
Usually result from movement of the brain within the skull.
Remember The inside of the skull is not smooth.
Two Types of Brain Injuries Concussion Contusions
BOTH are very serious injuries
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Mechanisms Brain Injuries1. Direct Blow or Repetitive Direct Blows
1. Coupe Injury: When a moving object strikes the stationary head, and the injury is at the site of impact.
2. Contrecoupe Injury: When a moving head strikes a stationary object, and brain rebounds off of the opposite side of the skull and causes an injury at the opposite side of impact.
2. Sudden Acceleration or Deceleration of head
Impact occurs away from the head, but the energy is transferred.
3. Combination of both
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Coupe vs. Countrecoupe Injury
Coupe Injury
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Reading Assignment
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Background Information
The brain can move in all directions and impact the inside of the skull.
Helmet to helmet football hits can occur in excess of 20 miles per hour.
Changes in brain velocity can reach up to 20 miles per hour during the game of football.
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Signs and SymptomsCognitive Pathological Behavioral
Disorientation Headache Irritability
Loss of Focus and difficulty concentrating
Loss of consciousness Abrupt changes in mood.
Immediate Memory Deficits
Nausea/Vomiting Changes in personality
Delayed Memory Deficits
Vision difficulties (Poor Depth Perception)Loss of Vision
Fatigue
Dizziness Sleep Disturbances
Ringing in Ears Uncharacteristic Behaviors(TEE)
Neck Pain
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Concussion Grading Criteria
Grade Classification
Symptoms
Grade I (Mild) No Loss of ConsciousnessTransient ConfusionPost Traumatic Amnesia and post concussion signs and symptoms that last less than 15 minutes.
Grade II (Moderate)
No Loss of Consciousness Transient ConfusionPost Traumatic Amnesia and post concussion signs and symptoms that last more than 15 minutes
Grade III (Severe) Any Loss of ConsciousnessBrief (seconds)Prolonged (minutes)
American Academy of Neurology
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Returning The Athlete To PlayGrade Criteria for Return to Play
Grade I •Must be symptom free within 15 minutes of the initial injury. •Must be able to physically exert themselves without symptoms returning.•Must be cleared by a licensed physician
Grade II •May return to play when they are symptoms free for 1 week.•Athlete must be able to physically exert themselves without symptoms returning.•Must be cleared by a physician.
Grade III Brief LOC•Same as Grade IIProlonged LOC•May return to play when they are symptom free for 2 weeks.•Must be able to physically exert themselves without symptoms returning.•Must be cleared by a licensed physician
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The Problem
1. Concussions are a “invisible” injury.
2. Proper diagnosis depends on the athlete to report “ALL” symptoms.
3. Athletes are not sure what they are feeling when the have a concussion.
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Reading Assignment
Read the last page of the handout that was given to you on Friday.1. What conclusion can you make
about the reporting rates of concussions?
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Reporting Rates• High School Athletic Trainers
• 4% - 8% of players reported having a concussion.
• High School Athletes• 15% – 70% reported having a concussion.
• The Bottom Line• Athletes do not report symptoms.
• Why?▫ They Do Not Want To Leave The Game▫ Afraid of Letting Down Coaches and Teammates.▫ They are not sure what they are feeling.▫ “Are you hurt or are you injured”?
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Dangers of a Second Impact
Second Impact Syndrome Occurs when an athlete sustains a direct or
indirect force to the head before recovering from the last concussion.
Dangers Increase in severity of symptoms. Increase in the amount of time that
symptoms hang around. Post Concussion Syndrome
DEATH Occurs in 50% of the cases
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Pace Lap
What is second impact syndrome? 4 minutes
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Second Impact Syndrome
Second Impact Syndrome Occurs when an athlete sustains a direct or
indirect force to the head before recovering from the last concussion.
Dangers Increase in severity of symptoms. Increase in the amount of time that
symptoms hang around. Post Concussion Syndrome
DEATH Occurs in 50% of the cases
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Reading Assignment
Please read page 574 and 575 and answer the following questions:1. What are five signs and symptoms of a
brain contusion?2. Which are objective and which are
subjective?3. What is aphasia?4. What can cause a hemorrhage?5. List and define the three types of
hematomas that can occur within the skull?
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Brain Contusions
AKA: Bruising of the Brain Cause
When the brain collides with any part of the skull. Effects
Decreased nerve function. Depending on the portion of the brain that is bruised.
Signs and Symptoms Numbness Weakness Loss of Memory Aphasia: Loss of speech or comprehension. General Misbehavior
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Brain Hemorrhage
Hemorrhage = Bleeding LIFE THREATENING CONDITION Causes
Direct or indirect blow to the head. Contact between the brain and inside of the
skull can damage or lacerated blood vessels.
The hemorrhaging can cause a hematoma. A pooling of blood within the tissues.
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Intracranial Hematomas
Subdural Hematoma Hematoma that develops between the
brain and the dura mater. Epidural Hematoma
Hematoma that develops between the skull and the dura mater.
Intracranial Hematoma Hematoma that develops within the brain.
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Subdural Hematoma
The most frequent cause of death due to trauma in athletics.
Tearing of the cerebral vessels between the brain and dura mater. Usually occurs as a result of a twisting
motion of the hemispheres. Bleeding may occur rapidly or slowly.
Symptoms may be present immediately or may not appear for hours or days after.
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Epidural Hematoma
Injury to the arteries between the skull and the dura mater. Usually associated with a skull fracture.
Bleeding occurs between the skull and the dura mater.
Hematoma occurs rapidly and signs and symptoms develop rapidly.
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Intracranial Hematoma
Occurs when blood vessels within the brain are disrupted.
Associated with cerebral contusions.
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Signs and Symptoms of Hemorrhages
Hematoma places pressure on the hemispheres of the cerebrum and causes a decreased Neurological Function. Altered levels of consciousness. Slowed pupil reactions Loss of movement Loss of speech. Etc……
Constant Re-evaluation is important.