EMERGENCY ACTION PLAN

On-person equipment

On-site equipment

Communication

Mock up!

COVERINGS OF BRAIN

COVERINGS OF BRAIN

Epidural Space

Subdural Space

Subarachnoid Space

Epidural Space - ArteriesSubdural Space - Veins

Cerebrospinal Fluid

SPACES AND CONTENTSSPACES AND CONTENTS

MAJOR STRUCTURES WITHIN SPACES.

Epidural space – Arteries

Subdural Space – Veins

Subarachnoid Space – Cerebrospinal Fluid (CSF)

Middle Meningeal A.

SUBDURAL SPACE

DURA

Arachnoid

General Comments

Relating to Concussions

Caused by direct force to the head or by ‘impulsive’ force transmitted to the head.

General Comments

Relating to Concussions

Rapid onset of short-lived impairment of neural function.

Acute clinical symptoms are functional, not structural in nature.

General Comments

Relating to Concussions

May or may not involve loss of consciousness.

Is typically associated with grossly normal structural imaging study.

DIRECT

INDIRECT

Rotation (Angular)

Movement

TRANSLATIONAL

FORCE

Acceleration-Deceleration Injury

Translation

A B

A B

A. Head Hits Object.

B. Brain Rebounds

Interference of Neural Function

Unconsciousness ?

1. Reticular Activating System

2. Cerebral Cortex

3. Brain Stem

FOCAL – can be seen by the trained eye.

DIFFUSE – can not be seen by the trained eye.

EPIDURAL HEMATOMA

SUBDURAL HEMATOMA

SKULL FRACTURE

Thickness of skull.

Magnitude and direction of impact

Size of impact area

(signs and symptoms)o Visible deformity

o Deep laceration

o Depression/ crepitus

o Discolouration

o CSF from ears or nose

Battle’s Sign

Raccoon Eyes

Halo Sign

Bruising behind the ear on the Mastoid Process.

INTRACEREBRAL BLEED

Focal injury involving small bleeds in the cortex, brain stem or cerebellum. Usually caused by a bruise as a result of the head stopping movement and the brain continues moving.

• very rare in sports.

• direct blow to side of head.

• Middle Meningeal A. is severed.

1

May have initial

L.O.C. from blow.

Regain and ‘normal’.

10-20 min. decline.

Headache, vomiting, drowsiness.

2

Decrease consciousness.

Dilate pupil on side of bleed.

Opposite side weakness.

Emergency……. Fatal3

Caused by acceleration of the head rather

than impact.

Three times more frequent than epidural.

Bleed under dura.1

(Signs & Sym.) Low pressure venous

bleeding clots slowly.

S&S may become evident for hours, days, weeks.

Sometimes accompanied by cerebral swelling.

2

(S&S of Increasing Pressure)

Severe headache – Nausea or vomiting – Confusion or Impairment of Consciousness - Rising B.P. – Falling Pulse – Changes in Emotion – C.N. problems (eye tracking). 3

CEREBRAL CONCUSSION

Criteria for SeverityConsciousness

Mental Confusion

Memory Loss

Tinnitus

Unsteadiness

Posttraumatic Amnesia

Retrograde Amnesia

Anterograde Amnesia

R. Cantu.. Journal of Athletic Training. Sept/01

RETROGRADE AMNESIA

“ partial or total loss of the ability to recall events that have occurred during the period immediately preceding brain injury.”

ANTEROGRADE AMNESIA

“ a deficit in forming new memory after the accident, which may lead to decreased attention and inaccurate perception.”

Postconcussion Signs and Symptoms

Depression, Dizziness, Drowsiness, Extreme Sleep, Fatigue, Feel ‘in fog’, Feel ‘slowed down’, Headache, Irritability, Memory problems, Nausea, Nervousness, Numbness/tingling, Poor balance, Poor concentration, Ringing in the ears, Sadness, Sensitive to light, Sensitive to noise, Trouble falling asleep, Vomiting.

CONCUSSIONS

Grade I

Grade II

Grade III

GRADE I

No loss of consciousness

Post traumatic amnesia or postconcussion signs or symptoms lasting less than 30 minutes.

Cantu. J.A.T. 2001. Vol 36(3): 244-248

GRADE IIL.O.C. less than 1 minute.

Posttraumatic amnesia or postconcussion signs or symptoms lasting longer than 30 minutes but less than 24 hours.

GRADE III

Unconscious over 1 min or posttraumatic amnesia lasting longer than 24 hours.

Postconcussion signs and symptoms lasting longer than 7 days.

RETURN TO PLAY FOLLOWING CONCUSSION

(in one season)If 1st Gr. I; return if asymptomatic for one week.

If 2nd Gr. I; out for 2 weeks if asymptomatic for one

week.

If 3rd Gr. I; zee ya next year!

Return to Play….. Con’t

If 1st Gr.2; return after asymptomatic for one week.

If 2nd Gr.2; 1 month minimum and must by asympt. 1 wk; consider terminating season.

If 3rd Gr.2; terminate season; may return to play next season if asymptomatic.

Return to Play … con’t

If 1st Gr.3; one month and may return if asymptomatic for one week.

If 2nd Gr.3; terminate the season and may play next year if asymptomatic.

Postconcussion

Syndrome

Headache

Impaired memory

Decrease Concentration

Irritable, depressedFatigue

Visual disturbance

Second Impact Syndrome

Rare.

After initial trauma.

Sudden swelling of the brain because

of increased blood flow to brain.

Usually fatal.

Vaso-Vagal

Syncope

Stimulation of Vagus N. at the brain stem (usually by sudden rotation of the head).

Dilation of peritoneal blood vessels (pooling of blood).

Decreased oxygen to brain because of decreased cardiac output.

Faint. Quick recovery.

DIFFERENCE?

PROTECTIVE EQUIPMENT

DEFLECTION

DISSIPATION

ABSORPTION

DISSIPATION

Dispersion – spread the impact over a larger area.

Deformation – The energy used to deform material.

Helmets can not prevent rotational or translation motion in the brain.

Heavy helmets and helmets with facial protection increase the potential for neck injury.

Mouth guards can reduce the rate of dental and jaw injuries but the reduction in cerebral injuries is largely theoretical and has never been proven scientifically.

The brain can not be conditioned to withstand repetitive trauma.

Damage is irreversible and cumulative.

Not all athletes wear helmets and, in many sports, rule changes are slow to happen.