Head, Neck, & Head, Neck, & Facial InjuriesFacial Injuries
Concussion DefinedConcussion Defined
A brain injury caused by a blow A brain injury caused by a blow to the head, face, neck or body to the head, face, neck or body OROR caused by hitting a hard caused by hitting a hard surface/object (ground, bat, surface/object (ground, bat, ball, opponent, etc)ball, opponent, etc)
CDC Fact Sheet for CoachesCDC Fact Sheet for Coaches
Concussion FactsConcussion Facts A concussion is a brain injuryA concussion is a brain injury All concussions are seriousAll concussions are serious Concussions can occur without a loss of consciousnessConcussions can occur without a loss of consciousness They can occur in any sportThey can occur in any sport It can be accompanied by one or more signs/symptoms It can be accompanied by one or more signs/symptoms
Headaches are the most common symptomHeadaches are the most common symptom Early recognition and proper management can prevent Early recognition and proper management can prevent
further injury or even deathfurther injury or even death Concussions are most often associated with normal Concussions are most often associated with normal
results MRI/CT Scansresults MRI/CT Scans It is not necessary to lose consciousness to have a It is not necessary to lose consciousness to have a
concussionconcussion
Concussion Facts for Concussion Facts for ChildrenChildren
Children are at higher risk of concussions Children are at higher risk of concussions due to continued brain development and due to continued brain development and decreased muscle tone and coordinationdecreased muscle tone and coordination
Children and teens are more likely to get Children and teens are more likely to get a concussion than adultsa concussion than adults
Children and teens take longer to recover Children and teens take longer to recover than adultsthan adults
Youth athletes are at greatest risk of Youth athletes are at greatest risk of catastrophic consequences from multiple catastrophic consequences from multiple concussionsconcussions
Sports Related Sports Related ConcussionsConcussions
As many as 3.8 million sports-related As many as 3.8 million sports-related concussions per yearconcussions per year
% of all sports related injuries:% of all sports related injuries: 6.5% (2002-2009)6.5% (2002-2009) 15% (2011)15% (2011) 20%-50%: Possible due to lack of 20%-50%: Possible due to lack of
reporting/hiding sxreporting/hiding sx Rates of incidents (in order):Rates of incidents (in order):
FB, Girls SOC, Boys SOC, Girls BB, FB, Girls SOC, Boys SOC, Girls BB, Wrestling, Boys BB, Cheer, SB, VB, BaseballWrestling, Boys BB, Cheer, SB, VB, Baseball
75% classified as mild 75% classified as mild
NY Daily News.com
Concussion ManagementConcussion Management
What to look for:What to look for:A forceful blow to the head or A forceful blow to the head or
bodybody
AND/ORAND/ORAny change in their behavior, Any change in their behavior,
thinking, or physical thinking, or physical functioningfunctioning
Concussion On-Field Concussion On-Field EvaluationEvaluation
Neck ExamNeck Exam General Neurologic ExamGeneral Neurologic Exam Mental Status ExamMental Status Exam
On-Field Evaluation: Neck On-Field Evaluation: Neck ExamExam
Examine when appropriate:Examine when appropriate: C-spine tendernessC-spine tenderness Dermatomes/MyotomesDermatomes/Myotomes
Care of the spine takes Care of the spine takes precedence over head injury precedence over head injury evaluationevaluation
Sideline Evaluation:Sideline Evaluation:History QuestionsHistory Questions
Previous concussionsPrevious concussions
Length of symptomsLength of symptoms
Time since fully Time since fully asymptomaticasymptomatic
Any LOC or Amnesia Any LOC or Amnesia
Sideline Evaluation: Sideline Evaluation: Concussion TestingConcussion Testing
Determine their symptomsDetermine their symptoms Any athlete w/ symptom(s) is to be removed Any athlete w/ symptom(s) is to be removed
from play until cleared by health care from play until cleared by health care professional!professional!
““When in doubt…sit them out!”When in doubt…sit them out!” Determine their level of consciousness Determine their level of consciousness
LOC >30sec LOC >30sec OROR decreased consciousness = decreased consciousness = 911911
Determine their orientation Determine their orientation Evaluate their memory (before & Evaluate their memory (before &
after) and their concentrationafter) and their concentration
Sx’s & SymptomsSx’s & SymptomsSeverity, duration, & number of sx = most Severity, duration, & number of sx = most
importantimportant
HeadacheHeadache DizzinessDizziness Nausea/Vomiting Nausea/Vomiting Blurred or double Blurred or double
visionvision FatigueFatigue Memory problemsMemory problems AmnesiaAmnesia Loss of consciousnessLoss of consciousness Sensitivity to noise or Sensitivity to noise or
lightlight
Vacant stareVacant stare Delayed responsesDelayed responses Decreased Decreased
alertness & alertness & concentrationconcentration
DisorientationDisorientation Poor coordinationPoor coordination Inappropriate Inappropriate
emotionalityemotionality Behavior or Behavior or
personality changespersonality changes
Sideline Evaluation:Sideline Evaluation:General Neurological ExamGeneral Neurological Exam
Cranial Nerves:Cranial Nerves: Pupillary evaluationPupillary evaluation Vision Vision BalanceBalance
GaitGait Coordination & Fine MovementsCoordination & Fine Movements Myotomes:Myotomes:
Muscle StrengthMuscle Strength Dermatomes:Dermatomes:
SensationSensation
12 Cranial Nerves12 Cranial Nerves I. Olfactory: Smell II. Optic: Vision/sight III. Oculomotor: PEARL IV. Trochlear: Look up V. Trigeminal: Facial sensation/clench jaw VI. Abducens: Lateral eye movement VII. Facial: Smile/frown/raise eyebrows VIII. Vestibularcochlear: Hearing/balance IX. Glossopharangeal: Swallow X. Vagus: Swallow/Say ahh XI. Accessory: Resisted shoulder shrug XII. Hypoglossal: Stick out tongue
MyotomesMyotomes
C5: Shoulder abduction C6: Elbow flexion/wrist extension C7: Elbow extension/wrist flexion C8: Ulnar deviation, thumb
extension T1: Finger abduction/adduction
DermatomesDermatomes C5: Lateral deltoid/arm C6: Lat. Forearm/thumb/index finger C7: Middle finger/forearm C8: 4th/5th phalanx/medial forearm T1: Medial arm
Sideline Evaluation Cont.Sideline Evaluation Cont. Orientation
Where are we playing? Who are we playing? What is the score?
Retrograde Amnesia What did they eat for breakfast that day?
Anterograde Amnesia Repeat words & try to recall (girl, dog, green)
Concentration Repeat days of week backward, start with
today Repeat these #s backward: 419 (914)
Post Concussion – General Post Concussion – General CareCare
Any Any symptomaticsymptomatic athlete must be held from play athlete must be held from play Have concussed athlete Have concussed athlete sit & monitoredsit & monitored Do not give them or let them take pain Do not give them or let them take pain
medicationmedication Contact parent(s)/guardian(s)Contact parent(s)/guardian(s) Check every 5 min for at least 15 minCheck every 5 min for at least 15 min Must be released to parent/guardian, or other Must be released to parent/guardian, or other
responsible adult party in their absence, with responsible adult party in their absence, with take home instructionstake home instructions Do not leave athlete unattended!Do not leave athlete unattended! Do not let them drive home, especially by Do not let them drive home, especially by
themselvesthemselves
Neuroimaging StudiesNeuroimaging Studies Consider for:Consider for:
Prolonged LOC (30 sec+)Prolonged LOC (30 sec+) Neurological deficitsNeurological deficits Post-traumatic seizuresPost-traumatic seizures Worsening symptomsWorsening symptoms Persistent symptoms > one weekPersistent symptoms > one week Any suspected structural injuryAny suspected structural injury
CT (acute bleeding) vs MRI (2-3 CT (acute bleeding) vs MRI (2-3 days: swelling) scansdays: swelling) scans
Any positive imaging findings Any positive imaging findings mandates termination of seasonmandates termination of season
Seek Immediate Medical Seek Immediate Medical Care If:Care If:
LOC LOC > 30 sec at time of injury, or any LOC > 30 sec at time of injury, or any LOC
after initial traumaafter initial trauma Severe or worsening headacheSevere or worsening headache Persistent nausea/vomitingPersistent nausea/vomiting Unusual behavior/Persistent mental Unusual behavior/Persistent mental
status alterationsstatus alterations Visual disturbancesVisual disturbances Worsening concussion symptomsWorsening concussion symptoms SeizuresSeizures
Post Concussion Post Concussion TreatmentTreatment
Complete Physical and Mental Complete Physical and Mental Rest:Rest: No exerciseNo exercise Absence from school?Absence from school? Decreased school work/postpone Decreased school work/postpone
reading, homework, and testsreading, homework, and tests No texting, reading, or computer useNo texting, reading, or computer use Communicate about return to learn & Communicate about return to learn &
play protocolsplay protocols
Concussion Risks Concussion Risks 3-5x’s more likely to get a subsequent 3-5x’s more likely to get a subsequent
concussion after receiving at least one concussion after receiving at least one previous head injuryprevious head injury
Repeated mild brain injuries occurring Repeated mild brain injuries occurring over an extended period (i.e., months or over an extended period (i.e., months or years) can result in years) can result in cumulative cumulative neurologic and cognitive deficits neurologic and cognitive deficits
Repeated mild brain injuries occurring Repeated mild brain injuries occurring within a short period (i.e., hours, days, within a short period (i.e., hours, days, weeks) can be weeks) can be catastrophic or fatalcatastrophic or fatal
Concussion RisksConcussion Risks A recent study found that NFL A recent study found that NFL
players who suffer multiple players who suffer multiple concussions are 30% more likely to concussions are 30% more likely to suffer clinical depression later in lifesuffer clinical depression later in life
Concussion RisksConcussion Risks Cerebral Edema:Cerebral Edema:
Brain swellingBrain swelling Increases intracranial pressure which can Increases intracranial pressure which can
cut off oxygen supply to braincut off oxygen supply to brain Can be fatal if not treated quicklyCan be fatal if not treated quickly
Epidural/Subdural Hematoma:Epidural/Subdural Hematoma: Bleeding in/around the brainBleeding in/around the brain Increases intracranial pressureIncreases intracranial pressure Can be fatal if not treated quicklyCan be fatal if not treated quickly
Signs:Signs: SSevere headache, dizziness, vomiting,
increased size of one pupil, or sudden weakness in an arm or leg
Concussion RisksConcussion Risks Second impact syndrome: Second impact syndrome: Rare, but fatal conditionRare, but fatal condition Occurs when a second head injury is Occurs when a second head injury is
sustained before the first has time to sustained before the first has time to completely healcompletely heal
Rapid brain swelling, which can result Rapid brain swelling, which can result in fatal complicationsin fatal complications
50% chance of death50% chance of death 100% chance of morbidity100% chance of morbidity
One or more of their senses may be One or more of their senses may be impaired either temporarily or permanentlyimpaired either temporarily or permanently
Story of Death: Case 1Story of Death: Case 1 October 1991, a 17-year-old HS FB player was tackled October 1991, a 17-year-old HS FB player was tackled
on the last play of the first half of a varsity game and on the last play of the first half of a varsity game and struck his head on the ground. struck his head on the ground.
During half-time, he told a teammate that he felt ill During half-time, he told a teammate that he felt ill and had a headache; he did not tell his coach or and had a headache; he did not tell his coach or athletic trainer. athletic trainer.
He played again during the 3He played again during the 3rdrd quarter and received quarter and received several routine blows to his helmet during blocks and several routine blows to his helmet during blocks and tackles. tackles.
He then collapsed on the field and was taken to a local He then collapsed on the field and was taken to a local hospital in a coma. hospital in a coma.
A CT-Scan revealed diffuse swelling of the brain and a A CT-Scan revealed diffuse swelling of the brain and a small subdural hematoma. small subdural hematoma.
He was transferred to a regional trauma center, where He was transferred to a regional trauma center, where attempts to reduce elevated intracranial pressure attempts to reduce elevated intracranial pressure were unsuccessful, and he was pronounced dead 4 were unsuccessful, and he was pronounced dead 4 days later. days later.
Story of Death: Case 2Story of Death: Case 2 August 1993, a 19-year-old college football August 1993, a 19-year-old college football
player reported a headache to family player reported a headache to family members after a full contact-practice during members after a full contact-practice during summer training. summer training.
During practice the following day he During practice the following day he collapsed on the field approximately 2 collapsed on the field approximately 2 minutes after engaging in a tackle. minutes after engaging in a tackle.
He was transported to a nearby trauma He was transported to a nearby trauma center where a CT scan showed diffuse brain center where a CT scan showed diffuse brain swelling and a thin subdural hematoma. swelling and a thin subdural hematoma.
Attempts to control the elevated intracranial Attempts to control the elevated intracranial pressure failed, and he was pronounced pressure failed, and he was pronounced brain dead 3 days later. brain dead 3 days later.
E:60 explores Preston Plevretes' life after
tragedy Plevretes, then a 19-year-old
sophomore at La Salle, received a second concussion while still symptomatic from his first
He was briefly knocked unconscious but then awoke and was combative for 3-5 minutes before lapsing into a coma
http://espn.go.com/video/clip?http://espn.go.com/video/clip?id=espn:5163151 id=espn:5163151
Concussion Grading Concussion Grading
Based on severity Based on severity ANDAND duration of duration of symptomssymptoms The more symptoms and the more severe the The more symptoms and the more severe the
symptoms are reported = more severe symptoms are reported = more severe concussionconcussion
Typically, the more sx the person reports Typically, the more sx the person reports and higher severity dictates a longer and higher severity dictates a longer recoveryrecovery
A concussion cannot be truly graded A concussion cannot be truly graded until the symptoms have stoppeduntil the symptoms have stopped
How long will it take to How long will it take to recover?recover?
A recent 2011 study looked at how long it took high school athletes symptoms to resolve/clear
23.5% - less than 24 hours 33.8% - 1 to 3 days 20.6% - 4 to 6 days 19.6 - 1 week to 1 month 2.8% - more than a month
Post Concussion Syndrome Post Concussion Syndrome (PCS)(PCS)
Weeks to Months of persistent symptoms Weeks to Months of persistent symptoms
Exercise can trigger or aggravate symptomsExercise can trigger or aggravate symptoms Symptoms at 3 months:Symptoms at 3 months:
HeadacheHeadache 42%42% Memory dysfunctionMemory dysfunction 36%36% FatigueFatigue 30%30% IrritabilityIrritability 28%28% DizzinessDizziness 26%26% Impaired concentrationImpaired concentration25%25% Sleep disturbanceSleep disturbance 20%20% Depressed mood Depressed mood 9%9%
Pharmacotherapy for Pharmacotherapy for PCSPCS
Acetominophen, NSAIDs, Excedrin Acetominophen, NSAIDs, Excedrin (Only Tylenol post acute concussion)(Only Tylenol post acute concussion)
Tricyclic Tricyclic AntidepressantsAntidepressants Anti-nausea MedicationAnti-nausea Medication Sleep AidsSleep Aids Beta-BlockersBeta-Blockers Calcium Channel BlockersCalcium Channel Blockers
Baseline & Sideline TestsBaseline & Sideline Tests ImPact ® ImPact ®
Neurocognitive Test Neurocognitive Test Verbal and Visual Memory Verbal and Visual Memory Reaction timeReaction time ConcentrationConcentration Symptom ChecklistSymptom Checklist
~20 min test; Computerized; Cost Associated w/ Test~20 min test; Computerized; Cost Associated w/ Test $350-$750/year depending on number of athletes/concussions$350-$750/year depending on number of athletes/concussions
Limitations: no balance score, cannot be used post-Limitations: no balance score, cannot be used post-injury on sidelines, long test, no 1-on-1 tester injury on sidelines, long test, no 1-on-1 tester interactioninteraction
Used by many professional, collegiate, and high Used by many professional, collegiate, and high school teamsschool teams
Baseline & Sideline Tests Baseline & Sideline Tests – Cont.– Cont. SAC SAC
Cognitive Test (Memory, concentration, orientation)Cognitive Test (Memory, concentration, orientation) ~5 min test; 1 page; Free ~5 min test; 1 page; Free
SCAT3SCAT3 Cognitive Test, Balance, Symptom Checklist, Other Cognitive Test, Balance, Symptom Checklist, Other
Evaluation Tools, & Take Home InstructionsEvaluation Tools, & Take Home Instructions ~7 min test; 3-4 pgs or use App; Free ~7 min test; 3-4 pgs or use App; Free Standard test for FIFA, Olympic Games, Rugby, & Standard test for FIFA, Olympic Games, Rugby, &
many othersmany others NFL Form (NEW)NFL Form (NEW)
Revised SCAT2 – No take home instructionsRevised SCAT2 – No take home instructions ~5 min test; 1-2 sheets of paper; Free~5 min test; 1-2 sheets of paper; Free Standard for all NFL teams Standard for all NFL teams
Concussion Evaluation Concussion Evaluation MaterialsMaterials
Concussion ResearchConcussion Research
University of Pittsburgh Medical CenterUniversity of Pittsburgh Medical Center Neuropsychological Testing (IMPACT)
Tests indicated cognitive deficits in asymptomatic athletes following 4 days post concussion
Deficits also found in reaction time and processing speed when asymptomatic
Research ContinuedResearch Continued 64 high school athletes with mild concussions
(“bell ringers”) 2 groups:
< 5 min signs/sx 5-15 min signs/sx
Used IMPACT for baseline, 2, 4 & 7 days post injury < 5min signs/sx group: had deficits that gradually
improved days 2-7. Back to baseline at day 7 5-15 min signs/sx group: had signif. deficits that
gradually improved days 2-7. No return to baseline at day 7!
Concussion LegislationConcussion Legislation
50 states, D.C., & Chicago have 50 states, D.C., & Chicago have adopted concussion laws (2014)adopted concussion laws (2014)
Washington State's concussion Washington State's concussion law became effective in July law became effective in July 2009, named for Zachery 2009, named for Zachery LystedtLystedt
Zachery LystedtZachery Lystedt Late in the first half after a big play,
his head hit the ground and he grabbed his helmet in obvious pain as he struggled to get up.
He made it to the sideline, sat out for about 15 min, and then went back in for the remainder of the game.
http://espn.go.com/video/clip?id=7525526
Lystedt Law & WIAA Guidelines
Removal of any athlete suspected of having a concussion from practice/game
Athletes cannot return to practice/game until evaluated by a licensed healthcare professional trained in the management of concussions and given written medical authorization
Parents and athletes are required to sign a concussion information sheet each year
School districts are required to work with the (WIAA) to develop guidelines for safe play
Private non-profit youth leagues using public fields must comply as well
Who Can Authorize RTP?Who Can Authorize RTP?
Medical Doctors (MD) Medical Doctors (MD) Doctor of Osteopathy (DO) Doctor of Osteopathy (DO) Advanced Registered Nurse Advanced Registered Nurse
Practitioner (ARNP) Practitioner (ARNP) Physicians Assistant (PA) Physicians Assistant (PA) Licensed Certified Athletic Licensed Certified Athletic
Trainers (ATC/L)Trainers (ATC/L)
Concussion PreventionConcussion Prevention
Teach proper technique/mechanicsTeach proper technique/mechanics Ensure proper equipment is worn Ensure proper equipment is worn
and that it fits properlyand that it fits properly Recommend/require mouth guardsRecommend/require mouth guards Teach good sportsmanshipTeach good sportsmanship Ensure your athletes are in good Ensure your athletes are in good
physical shape (Neck strength!)physical shape (Neck strength!)
Return To Play ProtocolReturn To Play Protocol
Assess initial injury, remove athlete from Assess initial injury, remove athlete from play, sideline SCAT2?, complete rest until sx play, sideline SCAT2?, complete rest until sx free free
DAY 1: 20 min Light Aerobic Activity DAY 1: 20 min Light Aerobic Activity DAY 2: 30 min Sport Specific Activity DAY 2: 30 min Sport Specific Activity DAY 3: Non-Contact Practice with teamDAY 3: Non-Contact Practice with team DAY 4: Full Contact Practice with no return DAY 4: Full Contact Practice with no return
of sx of sx DAY 5: Full Release by school ATC or team DAY 5: Full Release by school ATC or team
physician w/ a return to baseline SCAT2* and physician w/ a return to baseline SCAT2* and symptom free throughout all exertional symptom free throughout all exertional testingtesting
Concussion Education Concussion Education VideosVideos
espn.go.com/video/clip?id=5163151espn.go.com/video/clip?id=5163151 Preston Plevretes E60 VideoPreston Plevretes E60 Video
http://vimeo.com/15026404 http://vimeo.com/15026404 NATA’s Educational VideoNATA’s Educational Video
http://www.youtube.com/watch?http://www.youtube.com/watch?v=VH2KjItYXUY v=VH2KjItYXUY CNN Big Hits, Broken DreamsCNN Big Hits, Broken Dreams
Additional ResourcesAdditional Resources
CDCCDCHeads Up SportHeads Up Sport
NATANATANCAANCAAWIAA WIAA
Anatomy: SpineAnatomy: Spine Spinous ProcessSpinous Process C4-C7C4-C7 DiscDisc Nerve RootNerve Root
ROM: Neck & TrunkROM: Neck & Trunk
FlexionFlexion ExtensionExtension Lateral BendingLateral Bending RotationRotation
Postural Malalignments: Postural Malalignments: SpineSpine
Spinal Injuries: Spinal Injuries: Bulging/Herniated DiscBulging/Herniated Disc
Neck Injuries: Axial Neck Injuries: Axial LoadingLoading
A force applied to the top of the A force applied to the top of the head when the neck is partially head when the neck is partially flexed, which aligns the cervical flexed, which aligns the cervical vertebrae in a straight column vertebrae in a straight column
Neck is unable to handle the force Neck is unable to handle the force causing the cervical vertebrae to causing the cervical vertebrae to compresscompress Results in a fracture or dislocationResults in a fracture or dislocation
Neck Injuries: Axial Neck Injuries: Axial LoadingLoading
Primary cause for catastrophic Primary cause for catastrophic cervical spine injuries (CSIs) cervical spine injuries (CSIs) resulting in paralysis. resulting in paralysis.
Head-down contactHead-down contact: initiating : initiating contact with the top of the helmetcontact with the top of the helmet
Neck Injuries: Axial Neck Injuries: Axial LoadingLoading
Spearing:Spearing: intentional use of a head-down intentional use of a head-down contact technique. contact technique.
Unintentional head-down contact:Unintentional head-down contact: is the is the dropping of the head just before contact. dropping of the head just before contact.
Catastrophic CSIs from axial loading are not Catastrophic CSIs from axial loading are not prevented by players’ standard equipment.prevented by players’ standard equipment.
Eric LeGrand:Eric LeGrand:
http://www.youtube.com/watch?v=NMklSv_VlxE http://www.youtube.com/watch?v=NMklSv_VlxE
Anthony Conner:Anthony Conner:
http://www.youtube.com/watch?v=ITzuLkpb44k http://www.youtube.com/watch?v=ITzuLkpb44k
Neck Injuries: On-Field Neck Injuries: On-Field Acute ManagementAcute Management
Subjective: Hx, MOI, C/O, Med/All Red Flags: Tingling, numbness, motor loss, neck pain over
spinous process Observation:
Look for crown of helmet or head contact Look at body posture and movement capabilities
Palpation: Palpate spinous processes of cervical vertebrae
Special Tests: Active ROM:
Move hands and feet Resisted ROM/Myotomes:
Exp: Grip hand, resisted plantar flexion Dermatomes
DermatomesDermatomes
Neck Injuries: On-Field Neck Injuries: On-Field Acute ManagementAcute Management
Initial Care for Suspected Neck Initial Care for Suspected Neck Injury:Injury: Stabilize C-SpineStabilize C-Spine Call 911/Get AED???Call 911/Get AED??? Remove face maskRemove face mask
If athlete is NOT wearing shoulder pads, remove If athlete is NOT wearing shoulder pads, remove helmethelmet
Monitor A, B, C’sMonitor A, B, C’s Check for signs of concussion?Check for signs of concussion? If face down If face down and and not breathing…log roll not breathing…log roll
and begin CPRand begin CPR
Facial Injuries: EyeFacial Injuries: Eye Basketball & baseball are most Basketball & baseball are most
common sports common sports Most sports related eye injuries are Most sports related eye injuries are
from blunt traumafrom blunt trauma Exp: Golf ball to the eyeExp: Golf ball to the eye
Corneal abrasions Corneal abrasions Exp: Finger to eye during basketballExp: Finger to eye during basketball (Seen under blue light w/ stain)(Seen under blue light w/ stain)
Eye Injury – Immediate Eye Injury – Immediate ReferralReferral
Foreign-body Red eye Blood in/around
eye Halos around
lights Corneal edema
Laceration of the eye lid
Broken contact lens or shattered eyeglasses
Unable to look up Orbital floor fx possible
Sudden decrease in or loss of vision
Loss of field of vision
Pain w/ movement Diplopia
Double Vision Proptosis of the
eye Forward Displacement
of Eye Light flashes or
floaters Irregularly shaped
pupil
Facial Injuries: Facial Injuries: LacerationLaceration
Seen in basketball, field hockey, Seen in basketball, field hockey, baseball, softball, martial baseball, softball, martial arts/boxing, etcarts/boxing, etc
Management: Management: Stop bleedingStop bleeding Clean woundClean wound Apply Steri-stripsApply Steri-strips Cover woundCover wound Refer to Urgent Care for F/URefer to Urgent Care for F/U
Facial Injuries: NoseFacial Injuries: Nose Deviated SeptumDeviated Septum Fracture of Nasal BoneFracture of Nasal Bone Management:Management:
Stop bleeding Stop bleeding Observe & PalpateObserve & Palpate Refer for x-raysRefer for x-rays
Facial Injuries: Avulsed Facial Injuries: Avulsed ToothTooth
“Knocked-Out Tooth” Management:
Pick up tooth by the crown (the chewing surface) not the root ASAP
If dirty, gently rinse tooth with water or saline Do not use soap or chemicals Do not scrub, dry, or wrap up the tooth
Replace tooth in socket ASAP(if possible) Hold the tooth in place with fingers or by gently biting down on
it Keep tooth moist at all times.
Emergency tooth preservation kit Milk Cup of saliva Mouth (next to cheek)
Go to nearest available dentist within 30-60 minutes
Cauliflower EarCauliflower Ear
Caused by blunt trauma or repeated frictionCaused by blunt trauma or repeated friction Causes a hematoma which restricts blood flow to the Causes a hematoma which restricts blood flow to the
cartilage, leads to cartilage death/scarring & possible cartilage, leads to cartilage death/scarring & possible infectioninfection
As it heals it can shrivel up giving it a cauliflower-As it heals it can shrivel up giving it a cauliflower-like appearancelike appearance
Tx:Tx: Drain blood from hematoma, antibiotics, & Drain blood from hematoma, antibiotics, & reduce inflammationreduce inflammation
Without tx it is permanent, w/ prompt/aggressive Without tx it is permanent, w/ prompt/aggressive tx deformity is unlikelytx deformity is unlikely
Common in wrestlers, boxers, & martial artistsCommon in wrestlers, boxers, & martial artists