Head

1. Head

2. Etiology: Blunt trauma or a fall from a height Signs & Symptoms: Severe headache and nausea; palpation may reflect a defect such as a skull indentation; there may be blood in the middle field, blood in the ear canal, bleeding through the nose, ecchymosis around the eyes (raccoon eyes) or ecchymosis behind the ears (battle sign); cerebral spinal fluid may appear in the ear canal and nose Treatment: Hospitalization and neurosurgeon referral Skull Fracture

3. Etiology: Blunt trauma or a fall from a height Signs & Symptoms: Headache, tinnitus, nausea, irritability, confusion, dizziness, loss of consciousness, posttraumatic (anterograde) amnesia, retrograde amnesia, concentration difficulty, blurred vision, photophobia, sleep disturbance Treatment: Athlete is removed from play. May return to play if asymptomatic for 20 minutes. Cerebral Concussions(Mild Head Injuries)

4. Head Injury Guidelines

5. Etiology: Poorly understood condition that occurs following a concussion Signs & Symptoms: Athlete complains of a range of post-concussion problems, including persistent headache, impaired memory, lack of concentration, anxiety and irritability, giddiness, fatigue, depression and visual disturbances. These symptoms may begin immediately or within several days following the initial trauma and may last for weeks or even months before resolving. Treatment: Athlete is removed from play until all symptoms of this condition have resolved. Post-Concussion Syndrome

6. Etiology: Rapid swelling and herniation of the brain after a second head injury that occur before the symptoms of a previous head injury have resolved. The second impact may be relatively minor and, in some cases, may not even involve a blow to the head Signs & Symptoms: Often, the athlete does not even lose consciousness and may look stunned. The athlete may remain standing and be able to leave the playing field under his or her own power. However, within 15 seconds to several minutes, the athlete’s condition worsens rapidly, with dilated pupils, loss of eye movement, loss of consciousness leading to coma, and respiratory failure. This is a life-threatening situation! Treatment: Emergency hospitalization. The best treatment is prevention. Second Impact Syndrome

7. Etiology: Blunt trauma Signs & Symptoms: Athlete may experience a loss of consciousness but subsequently becomes very alert and talkative. A neurological exam will be normal, however, symptoms such as headaches, dizziness, and nausea will persist Treatment: Hospitalization Cerebral Contusion

8. Etiology: A blow to the head or a skull fracture causing a tear of the menigeal arteries which are embedded in the bony grooves of the skull Signs & Symptoms: Athlete may experience a loss of consciousness but subsequently becomes lucid and show few or none of the symptoms of a serious head injury. Gradually symptoms begin to worsen and the athlete begins to experience severe head pain; dizziness, dilation of the pupil (usually on the same side of the injury), and sleeplessness. This can degrade into a life-threatening situation. Treatment: Hospitalization Epidural Hematoma

9. Etiology: Occur more frequently than an epidural hematoma; results from acceleration/deceleration forces that tear vessels that bridge the dura mater and the brain. Signs & Symptoms: Athlete may loose consciousness; the athlete may experience severe headache; dizziness, dilation of the pupil (usually on the same side of the injury), and sleepiness. This can degrade into a life-threatening situation. Treatment: Hospitalization Subdural Hematoma

10. Etiology: Occurs within minutes to hours after head trauma and is caused by an intracerebral clot that results in diffuse brain swelling with little or no brain injury. Signs & Symptoms: Rapid neurologic deterioration from a normal alert state that progresses to a coma and occasionally death. Treatment: Emergency hospitalization Malignant Brain Edema Syndrome

11. Etiology: Athlete has a history of repeated minor blows to the head or who has sustained a major cerebral injury; the exact cause is unknown, but the condition is believed to be a vascular disorder Signs & Symptoms: Flashes of light, blindness in half the field of vision (hemianopia), and paresthesia thought to be caused by vasoconstriction of intercerebral vessels. The athlete complains of a severe headache that is diffused throughout the head and often accompanied by nausea and vomiting. There is evidence of a familial predisposition. Treatment: Medication Migraine Headaches

12. Etiology: Blunt or penetrating trauma Signs & Symptoms: Possible bleeding, pain, and point tenderness Treatment: Pressure with a sterile gauze, cleanse the wound thoroughly, then dress. Possible physician referral. Scalp Injuries

13. Etiology: Direct blow Signs & Symptoms: Deformity, loss of normal occlusion of the teeth, bleeding around the teeth, lower lip anesthesia Treatment: Immobilize the jaw with an elastic bandage, physician referral Mandible Fracture

14. Etiology: Side blow to an open mouth Signs & Symptoms: Locked in an open position, jaw movement almost impossible, overriding malocclusion of the teeth Treatment: Immobilize the jaw with an elastic bandage and ice, physician referral, soft diet, and NSAIDs Mandible Dislocation

15. Etiology: Forward translation of the jaw Signs & Symptoms: Headache, earache, vertigo, inflammation, neck pain Treatment: Strengthening exercises for hypermobility; mobilization exercises for hypomobility; custom-fitted mouthpiece Temporomandibular Joint Dysfunction

16. Etiology: Direct blow Signs & Symptoms: Deformity, nosebleed, seeing double (diplopia), numbness Treatment: RICE, physician referral Zygomatic Complex (Cheekbone) Fracture

17. Etiology: Direct blow Signs & Symptoms: Pain while chewing, malocclusion, nosebleed, double vision (diplopia), numbness in the lip and cheek Treatment: RICE, immobilize, physician referral Maxillary Fracture

18. Etiology: Direct impact with a sharp object or by an indirect compressive force Signs & Symptoms: Pain, substantial bleeding, obvious tearing, Treatment: Pressure with a sterile bandage, dress the wound, possible physician referral Facial Laceration

19. Etiology: Any type of impact Signs & Symptoms: Possible bleeding, broken tooth Treatment: May not require immediate treatment, if the tooth is not sensitive, the athlete can play. Place tooth in a plastic bag and refer to a dentist. Must play with a mouth guard. Tooth Fracture

20. Etiology: Any type of impact Signs & Symptoms: Tooth is loosened or dislodged; little or no pain; Treatment: May not require immediate treatment, if the tooth is not sensitive, the athlete can play. Place tooth in a plastic bag and refer to a dentist. Must play with a mouth guard. Tooth Subluxation,Luxation, Avulsion

21. Etiology: Direct blow from the side or straight frontal force Signs & Symptoms: Profuse hemorrhage, swelling, deformity, palpation will reveal abnormal mobility and crepitus Treatment: Ice and compression, x-ray referral, protection Nasal Fracture andChondral Separation

22. Etiology: Direct blow Signs & Symptoms: Profuse bleeding, possible nasal pain Treatment: Ice and compression, possible doctor referral Nosebleed (Epistaxis)

23. Etiology: Compression or shearing injury Signs & Symptoms: Hemorrhage and fluid accumulation Treatment: Apply some friction reducing agent (petroleum jelly), the athlete must wear head gear. If the ear is “hot”, apply ice Auricular Hematoma (Cauliflower Ear)

24. Etiology: Fall or slap to the unprotected ear Signs & Symptoms: Loud pop followed by pain in the ear; nausea, vomiting, and dizziness; loss of hearing and a visible tearing of the membrane Treatment: Small to moderate tears usually heel spontaneously in one to two weeks. Infection can occur and must be continually monitored. Possible physician referral Rupture of the Tympanic Membrane

25. Etiology: Direct blow Signs & Symptoms: Ecchymosis and pain Treatment: Ice and compression, athlete should not blow their nose due to the possible increase in eye hemorrhage Orbital Hematoma (Black Eye)

26. Etiology: Direct blow from the side or straight frontal force Signs & Symptoms: Diplopia, restricted eye movement, downward displacement of the eye, pain, swelling, hemorrhage, numbness Treatment: Physician referral, antibiotics, possible surgery Orbital Fractures

27. Etiology: Any circumstance where there are particles and no eye protection Signs & Symptoms: Pain and disability Treatment: Flush with water Foreign Body in the Eye

28. Etiology: Abrading force, usually from a foreign body in the eye Signs & Symptoms: Pain, watering of the eye, photophobia, eyelid spasm Treatment: Cover eye with a patch, physician referral Corneal Abrasions

29. Etiology: When the heart is compressed between the sternum and the spine by a strong outside force Signs & Symptoms: Severe shock, heart pain, certain arrhythmias, decreased cardiac output Treatment: Medical emergency, must be transported to the hospital as quickly as possible, may need to begin CPR, treat for shock Heart Contusion

30. Etiology: Usually a caused by some congenital cardiovascular abnormality, the three most prevalent being hypertrophic cardiomyopathy, anomalous origin of the coronary artery, and Marfan’s syndrome Signs & Symptoms: Chest pain or discomfort during exertion, heart palpitations or flutters, syncope, nausea, profuse sweating, heart murmurs, shortness of breath, malaise, and fever Treatment: Prevention through counseling, screening, and early identification of preventable causes of sudden death. Medical emergency, must be transported to the hospital as quickly as possible, may need to begin CPR Sudden Death Syndromein Athletes

31. HOPS History Observation Palpation Special tests Head Evaluation

32. Neuralogic exam Cerebral Function - Questions that assess general affect: What’s your name? What happen? Cerebral Function - Questions that assess level of consciousness: Where are you? What time (day) is it? What’s the score? Cerebral Function - Questions that assess intellectual performance: Count backward from 100 by 7’s. Months backward. Cerebral Function - Questions that assess emotional status: Are they being erratic? Head Evaluation

33. Neuralogic exam Cerebral Function - Questions that assess thought content: Memorize three words. Cerebral Function - Questions that assess sensory interpretation: Blurred vision? Hearing problems. Cerebral Function - Questions that assess language skills: Slurred speech. Speech impared? Reflex testing Sensory (dermatome) testing Pupil response: PEARL (Pupils equal and reactive to light) Head Evaluation

34. Cranial Nerve Function Sense of smell (I. Olfactory) Eye tracking (II. Optic, III. Oculomotor, IV. Trochlear, VI. Abducens) Imitations of facial expressions (V. Trigeminal, VII. Facial) Biting down (V. Trigeminal) Balance (VIII. Vestibulocochlear) Hearing (VIII. Vestibulocochlear) Swallowing (IX. Glossopharyngeal, X. Vagus, XI. Accessory, XII. Hypoglossal) Strength of shoulder shrugs (XI. Accessory) Speak (XII. Hypoglossal, X. Vagus) Tongue protrusions (XII. Hypoglossal) Head Evaluation

35. Cerebellar Function Finger to nose Finger to examiner’s finger Drawing alphabet in the air with the foot Heel-toe walking Rhomberg’s Balance Test – eyes shut with one foot in the air Head Evaluation