SMED UNIT 6- HEAD AND NECK

PEARL

pupil equal and reactive to light

Cranial nerves

12 nerve pairs that begin in areas of the brain. They are designated by number and name

Cognitive testing

study the effects of head trauma on cognitive function (mental processes that allow us to carry out common tasks)

Alert

awake and responds immediately and appropriately

confused

impaired memory, disorientation and confusion

Lethargic

drwosy yet easily arouswed, oriented to persono, place and time

Stuporous

asleep most of the time, difficult to arouse, responds inappropriately

Semicomatose

no response to verbal stimuli, some response to painful stimuli

comatose

no response

epistaxis

bloody nose

anterograde amnesia

length of time from injury until conscious memory returns

retrograde amnesia

loss of memory of events that occurred before the injury

immediate recall

can recite 4-5 words or numbers right after you say them

Tinnitus

ringing in the ears

Rhomberg’s test

balance testing for intracranial damage

Diplopia

double vision

Acronym for cranial nerves…

On Old Olympus Towering Tops, A Finn And Greek Viewed Some Hops

Olfactory

Smell (I)

Optic

vision (II)

Oculomotor

eye movement, constriction of pupil (III)

Trochlear

eye movement (IV)

Trigeminal

head and face sensation (V)

Abducens

lateral movement of the eye (VI)

Facial

taste, facial movements (VII)

Acoustic

hearing and equilibrium (VIII)

Glossopharyngeal

swallowing (IX)

Vagus

speech (X)

Spinal Accessory

movement of neck and spine (XI)

Hypoglossal

movement of the tongue (XII)

Skull Fracture

Blunt trauma to head.

S/S- blood and/or CSF in ear or nose, severe headache, nausea, skin indentation

T/X- 911

Concussion

Direct or indirect trauma to head

S/S- confusion, headache, dizziness, trouble concentrating, abnormal pupil response

T/X- take out of play, determine LOC, watch for symptoms to worsen

Intracranial Hemorrhage

Blow to head (may be a slow bleed)

S/S- show signs of mild headache but then has sever head pains, dizziness, nausea, unequal pupils.

TX- referral to the ER

Epidural Bleeding (FAST)

blow to the head

S/S- extremely fast bleeding, arterial. (in 10-20 min the athlete will go grom fine to having major symptoms

TX- ER, surgery

Subdural Bleeding

__Veins__ are torn that bridge the dura mater to the brain (Contrecoup)

S/S- bleeding is slow, s/s may not appear for hours

TX- 911 after s/s appear

Countercoup

occurs at site opposite of impact

Intracerebral bleeding

Force trauma to being (bleeding within the brain)

S/S- deterioration of neurological function

TX- 911, ER

Post Concussive Syndrome

Happens after head injury

s/s- impaired memory, lack of concentration, anxiety, depression

TX- may not return to play until symptoms are gone and have been cleared by a health care provider

Second impact Syndrome

Second head injury before S/S of initial injury go away ( caused 50 deaths over the last decade)

S/S- appear stunned, within short time athlete may collapse, dilated pupils, loss of eye movement, respiratory failure.

TX- prevention

Chronic Traumatic Encephalopathy (CTE)

Repetitive blows to the head (progressive degenerative brain disease

S/S- depression, mood changes, impulse control problems (eventually causes dementia)

TX- no cure

Cerebellum (SMALL)

Motor function, balance, posture

Cerebrum (LARGEST)

Voluntary movements

Sensory

Motor functions

Consciousness depends on excitation of the cerebral cortex

Cerebrospinal fluid

between arachnoid and pia mater (subarachnoid space)

\-Suspends brain

\-Cushions it from shock

Meninges (4 LAYERS)

Dura Mater- Dense, inelastic, outermost matter

Arachnoid membrane- thin, delicate membrane, attached to the spinal cord by small tissue strands

Subarachnoid space- in between the arachnoid and the pia mater. Helps contain the spinal fluid

Pia Mater- innermost layer

 

Cranium consists of large FLAT bones…

Frontal, Occipital, 2 Sphenoid, 2 Parietal, 2 Temporal

Brainstem

Medulla- heart, lungs motor

Pons and midbrain- reflexes

Hops (Questions)

Note length of time unconscious for 

Alert-comatose

Headache- Location, type 

Memory- immediate recall, recent memory

QUESTIONS-

* Do you know where you are
* What happened
* Does your head hurt
* Do you have pain in your neck
* can you move your hands and feet

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hOps

obvious deformity

slurred or incoherent speech

gross disturbance in coordination

length of time athletes affects abnormal

swelling or bleeding from scalp

discoloration

disorientation

delayed verbal and motor responses

hoPs

-skull deformity

\-open wounds

\-palpate both neck and skull

hopS

BALANCE TESTS-

Rhomberg (stand with eyes closed, single leg and tandem stance)

BESS (balance error scoring system)

COORDINATION TESTS-

finger to nose

heel-to-toe walk

heel to knee test

CONGITIVE TESTS-

count backwards from 100 by 7

spelling a word backwards

3 word recall

name the months in reverse order

Special Tests (neurological exam)

Cerebral testing- cognitive function

Cranial nerve testing- rule out isolated injury

Cerebellar testing- coordination and motor function

Sensory testing- dermatomes

Reflex testing

CAM Log

Cognitive Activity Monitoring Log

What is the first step in any concussion management plan

the institution of both physical and cognitive rest

What does cognitive rest possibly include?

no school attendance, no home/school work, no reading, no video games, no texting, no computer time, and no television

mTBI

mild traumatic brain injury

RTL

return to learn

when should you stop the cognitive activity when returning from a brain injury

after mild symptoms develop and before severe symptoms develop

Idaho concussion law is under house bill NO.

577

what are the stages of the symptoms monitoring tool or RTL plan

1. NO activity
2. Gradual reintroduction of cognitive activity
3. Homework at home before schoolwork at school
4. School re-entry
5. Gradual reintegration into school
6. Resumption of full cognitive workload

Home care OK TO

ice pack for head and neck, eat light diet, go to sleep, rest, tylenol

Home care NO NEED TO

check eyes with flashlight, wake up every hour, test reflexes, stay in bed

Home care DO NOT

drink alcohol, eat spicy foods, drive

Gradual RTP Protocol

Step 1- light aerobic exercise

Step 2- Sport specific exercise

Step 3- noncontact training drills and resistance training.

Neurocognitive test=

PASS- non contact training drills and resistance training

FAIL- retake in 48 hours

Step 4- full contact practice

Each step of RTP is….

a full 24-hour period. if symptoms return athlete drops back one level

External occipital protuberance

bump of knowledge

Where is CSF

between arachnoid and pia mater

What does CSF do

suspends brain, and cushions it from shock

Meninge layers