Unit 14

1. Unit 14 Injuries to the Head and Spine

2. Head and Spinal Injuries • Any injury to the head or spine is very serious • A head trauma • Can cause the brain to bleed • Can fracture the skull • Can even send a fragment of the skull into the brain

3. Head and Spinal Injuries • Spinal injuries are very serious • Can be life threatening and can cause paralysis • Spinal cord • Serves as the communication pathway between the brain and the rest of the body

4. Head and Spinal Injuries • Sports that carry a higher risk of neck injury • Gymnastics • Ice hockey • Basketball • Football • Diving • Extreme sports

5. The Nervous System • The main components: • Brain, cranial nerves, spinal cord, spinal nerves and peripheral nerves • System is highly organized and intricate • Coordinating and regulating the body’s many responses to internal and/or external environmental changes

6. The Nervous System • Basic structural unit of the nervous system is the nerve cell, or neuron • The neuron causes the body to react to its environment

7. Nervous System Divisions • Central nervous system (CNS) • Peripheral nervous system (PNS)

8. The Central Nervous System • The central nervous system • Consists of the brain and spinal cord • The brain • Surrounded by a protective barrier of membranes called meningesand CSF • Dura mater • Pia mater • Arachnoidmater • CSF • Cerebrospinal fluid

9. The Central Nervous System • Parts of the brain include: • Ventricles • Cerebrum • Cerebellum • Midbrain • Pons • Medulla oblongata

10. The Central Nervous System • Spinal cord • Attached to medulla oblongata of the brain and continues down to the first or second lumbar vertebrae of the back • Protected by the vertebrae, cerebrospinal fluid, and meninges

11. The Central Nervous System • Spinal cord’s two major functions are: • Conduct impulses through nerves • Connect body parts to the brain

12. The Peripheral Nervous System • Outside the central nervous system • Responsible for gathering information and carries the response signals to and from the central nervous system

13. The Peripheral Nervous System • Composed of the nerves located outside the brain and spinal cord • System is subdivided into the somatic and autonomic nervous system

14. The Peripheral Nervous System • Two divisions of the peripheral nervous system: • Somatic • Autonomic • Sympathetic nervous system • Parasympathetic nervous system

15. Evaluating a Head and Spinal Injury • If an athlete is down and unconscious • Always treat the athlete as if he or she has a possible head or spinal injury

16. Concussions • Caused most frequently by direct blows to the head • Show video clip • Sudden jerks of the head and neck can also produce concussions • Causes immediate symptoms • Headache, dizziness, nausea, disorientation and confusion resulting from swelling at the point of contact

17. Post-Concussive Symptoms • Any loss of consciousness • Persistent low-grade headache • Poor concentration • Retrograde amnesia • No memory of the time immediately before the injury

18. Post-Concussive Symptoms • Anterograde amnesia • No memory of being injured or of the time after the injury • Sleepiness

19. Post-Concussive Symptoms • Loss of coordination • Slurred or incoherent speech • Irritability • Anxiety, depression • Ringing in the ears

20. Post-Concussive Symptoms • Vacant stare and disorientation • Nausea and/or vomiting • Pupils do not react evenly to light or are unresponsive

21. Concussion Testing • Baseline, time of injury, and return to play • Standard Assessment of Concussion • SPORT • SCAT • Balance Error Scoring System • IMPACT • Axon

22. Second Impact Syndrome • Second impact syndrome • Second concussion is received before signs and symptoms of 1st concussion is resolved. • Second impact may be relatively minimal and not involve contact w/ the cranium • Life threatening

23. Signs of Injury • Often athlete does not LOC and may looked stunned • W/in 15 seconds to several minutes of injury athlete’s condition degrades rapidly • Dilated pupils, loss of eye movement, LOC leading to coma, and respiratory failure • Care • Life-threatening injury that must be addressed w/in 5 minutes w/ life saving measures performed at an emergency facility • Best management is prevention from the ATC’s perspective

24. Guidelines/Laws/Policies • NATA Concussion Guidelines, • AIA • Policy (football) • Education • Player-Brainbook • Coach NFHS Concussion Course • Parents (CDC Heads Up) • AIA form • SB1521

25. Return to Play • *Athlete is cleared when asymptomatic for 1 week* • All return to play should be gradual

26. Hematomas • Epidural hematoma • Cause of Injury • Blow to head or skull fracture which tear meningeal arteries • Blood pressure, blood accumulation and creation of hematoma occur rapidly (minutes to hours) • Signs of Injury • LOC followed by period of lucidity, showing few signs and symptoms of serious head injury • Gradual progression of S&S • Head pains, dizziness, nausea, dilation of one pupil (same side as injury), deterioration of consciousness, neck rigidity, depression of pulse and respiration, and convulsion

27. Care • Requires urgent neurosurgical care; CT is necessary for diagnosis • Must relieve pressure to avoid disability or death

28. Subdural Hematoma • Cause of Injury • Result of acceleration/deceleration forces that tear vessels that bridge dura mater and brain • Venous bleeding (simple hematoma may result in little to no damage to cerebellum while more complicated bleed can damage cortex) • Signs of Injury • Athlete may experience LOC, dilation of one pupil • Signs of headache, dizziness, nausea or sleepiness • Care • Immediate medical attention • CT or MRI is necessary to determine extent of injury

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30. Injuries to the Ear • Cauliflower ear Acute Chronic

31. Otitis externa • Swimmer’s ear • Rupture of the tympanic membrane • Foreign bodies in the ear

32. Injuries to the Eye Corneal abrasions or lacerations • Contusions • Retinal detachment • Foreign bodies and embedded objects

33. Fractures • Orbital roof and blowout

34. Injuries to the Eye • Conjunctivitis • Sty • Ruptured globe • Hyphema • Contact lens complications

35. Injuries to the Nose • Nosebleeds • Epistaxis • Nasal fractures • Nasal septal deviation • Nasal septal hematoma

36. Injuries to the Mouth and Jaw • Temporomandibular joint dislocation • Jaw fractures

37. Dislocations and fractures of the teeth • Exposed nerve

38. Soft Tissue Injuries from teeth

39. On July 9th 1989, in the Sunnyside section of Queens, a 15 year old boy was playing ball in the court yard of his apartment building. The ball landed over a tall iron picket fence. While climbing over the fence to retrieve the ball, the boy slipped and an iron spike impaled the boy through his neck and came out of his mouth. The boy was extremely lucky. The spike missed his jugular by a few centimeters. The boy was stuck on the fence hanging, unable to move. The Police and fire departments were called. http://stevespak.com/spak/ems/impaled.html

40. Firefighters, Police Emergency Service, and EMS personnel arrived at the scene, and had to immobilize the boy against the fence.

41. Firefighter Mike Loftus from Rescue Company 4 used an acetylene torch to cut the fence.

42. Rescue personnel supported & protected the boy with a fire extinguisher, that cooled of the area while the fence was being cut.

43. The fence was cut all around the boy. The boy was immobilized to the fence. The boy & the fence had to be removed to the hospital to prevent further injury. The boy & the fence had to be carefully removed to the ambulance.

44. The boy suffered a fractured Jaw & lost a couple of teeth. He spent a week in the hospital. Rescue company 4 went into the operating room to assist doctors with removing the spike from the boys neck. It was a sucessful rescue. The section of fence that was cut now hangs in the quarters of Rescue Company 4.