neurological injury evaluation and management

retrograde amnesia

the inability to remember events before the time of the injury

anterograde amnesia

the inability to remember events after the time of injury

what are questions to ask an athlete to determine a concussion

do you know where you are and what happened? can you remember who we played last week? can you remember walking off the field? does your head hurt? do you have pain in your neck? do you have tinnitus? can you move your hands and your feet?

true or false: you always assume spinal injury until they are cleared

true

true or false: when an athlete is nocked unconscious, it is assumed they have a concussion

true

what do you observe for a concussion

is the patient disoriented? are they able to tell what time and day it is? do they know where they are? Do they have a blank or vacant stare? can they keep their eyes open? is there slurred speech/incoherant speech? are there delayed verbal and motor responses? are their gross distrubances to coordination

decorticate posturing

abnormal position that intales flexion of fingers, wrist, elbows, and forearms on the chest, legs are extended and are rotated slightly inward. this indicated damage along the pathways controlling messages from the cortex of the brain to the spinal cord

decerebrate posturing

upper and lower extremities in extended position, arms will be at the patients sides, and the neck will be arched into extension. this indicated possible damage to the brain stem

what do you palpate for when evaluating a concussion

neck and skull for point tenderness and deformity. check scalp for any lacerations

neurological exam

assess cerebral testing, cranial nerves, cerebellar testing, sensory and reflex testing

how do you test eye function

pupils equal and reactive to light (using pen light), eye tracking: smooth or unstable which is also called nystagmus, do they have blurred vision

what are the different balance tests that can be performed

romberg test: determines individuals ability to stand and remain motionless, and balance error scoring system (BESS): clinical battery of tests that are used both firm and foam surfaces and errors are tabulated when the patient opens their eyes, takes hands off hips, steps/stumbles or falls

what do you do for a coordination test

finger to nose, heel to toe walking

what are the cognitive tests that can be performed

serial 7’s, months in reverse order, counting backwards, 3 word recall, breakfast, game, score of contest

what is the recommended took to asses a concussion: although one tool has not been demed the best

SCAT 6

SCAT 6

standardized assessment of concussion (SAC) is a brief mental status test to assess orientation, immediate memory recall, concentration, and delayed recall on and off the field

what is the most common cause of a skull fracture

blunt trauma

what are the signs and symptoms of a skull fracture

severe headache and nausea, palpation may feel like it is squishy or it will give away, may be blood in ear or ear canal and the nose, raccoon eyes, battle signs, or cerebrospinal fluid may come out of ears and nose

what are the different signs and symptoms of a concussion

somatic (headache), cognitive (feeling like in a fog), emotional (lability), physical (loss of consciousness, amnesia) behavioral changes (irritability), cognitive impairment (slowed reaction time), sleep distrubances (drowsiness)

if their is a loss of consciousness what should be assumed

cervical spine injury

what is return normal baseline requirement?

3-5 days

persistant post concussion symptoms

it is a condition which occurs following a concussion, patient complains of a range of post concussion problems: headaches, impaired memory, lack of concentration, anxiety and irritability, giddniess, fatigue, depression, visual disturbances. May begin immediately following injury and may last for weeks to months

when can a patient be returned to play when they have persistant post concussion symptoms

when the patient does not experience symptoms anymore

second impact syndrome

results in rapid swelling and herniation of the brain after a second head injury before symptoms of the initial injury have resolved, can be relatively minimal and not involve contact with the cranium. within 15 seconds to several minute of injury patients condition degrades rapidly

what is the procedure for second impact syndrome

the patient needs to be life flighted, and must be addressed within 5 minutes with life saving measures performed at an emergency facility

what are the signs and symptoms of second imact syndrome

dilated pupils, loss of eye movement, loss of consciousness leading to coma, and respiratory failure

what was the king devicks test designed for

baseline testing and sideline concussion testing and evaluation, which tests for visual performance

how many G-forces are linked to a concussion

one single hit greater than 98G linked to risk of concussion, but multiple hits more than 65G linked to risk of concussion

how long should the acute rest phase be for activity of daily living

24 to 48 hours

STUPOR

decreased state of mental activity or awareness associated with drowsiness or diminished response, short unconsciousness when the patient can be awakened or will respond to stimuli (may appear incoherent or disoriented) can occur as a result of head injury

STUPOR can be a symptom of

drug or alcohol abuse, advanced heat illness, isulin shock, and hypoglycemia

what is the emergency care for STUPOR

if the patient is difficult to arouse, provides incoherent responses and/or returns to semiconscious state after being aroused, activate EMS transport to emergency room, assess vitals, amount of disorientation and amount of difficulty arousing patient

coma

a deep state of unconsciousness where the patient does not react or respond to stimuli, does not respond to verbal visual, tactile or painful stimuli comes from serious head injury, consuming large amounts of alcohol or drugs, diabetic reaction, hemorrhage in the brain, more common in high force collision sports

seizures

changes in the persons level of consiousness due to the occurance of sudden uncontrolled abnormal electrical activity in the brain, can be caused by epilepsy, head injury, fever, poisoning, and insulin shock

what are the phases of a seizure

tonic: stiffening of muscles victim will collapse, clonic phase: muscle spasms and convulsions

emergency care for seizures

do not restrain patient, protect from injury, monitor vital signs, provide support and assistance as patient reorients, call 911 is seizure lasts more than 5 minutes, repeat without the victim regaining consciousness, and occurs after head injury or medical emergency

partial seizure

only part of the brain is affected by abnormal activity, spasms are limited to area controlled by the afected part of the brain, victim most likely will not lose consciousness, and there is a quick recovery

post-ictal period after seizure

5 to 30 minutes, characterized by: extreme fatigue, memory loss, confusion, embarrassment, muscle soreness, bruising, headache, fear