Head and Face Injuries

Cerebral Concussion

• Definition: immediate and transient posttraumatic impairment of neural functions

• Estimated 250,000 or more a year

• Can take up to 30 minutes or 1 hr for symptoms to appear

• There are a variety of grading scales and return to play criteria. It is best to have a protocol determined by your athletic staff, ATC and physician.

• Always handle head trauma with great caution

• For more information on concussions or health issues go to www.cdc.gov

• There is a Free CDC Tool Kit on Concussions for High School Coaches!

• If your athlete sustains a head injury and there is no medical professional, it is always best to treat the situation with the most conservative care possible.

• Each situation will be different and you may have to obtain parents consent when dealing with a minor.

• An MD clearance note should always be encouraged

Cerebral Concussion

• Signs and symptoms:– Dizziness– Disorientation– Headache– Amnesia– Tinnitus (ringing in the ears)– Balance problems– Nausea/vomiting– Change in personality

Cerebral Concussion

• American Academy of Neurology Concussion Grading Scale

• Grade 1 (mild) Transient confusion; no LOC*; symptoms and mental status abnormalities resolve <15 min

• Grade 2 (moderate) Transient confusion; no LOC; symptoms and mental status abnormalities last >15 min

• Grade 3 (severe) Any LOC *LOC indicates loss of consciousness

Cerebral Concussion

• What do you do?

• #1: sit athlete down and ask questions and observe signs and symptoms - ask questions related to memory and orientation to rule out amnesia

• Questions:– Do you know where you are? – Can you tell me what happened? – Do you know who we are playing?– Do you have pain in your neck?– Do you remember who we played last week?

Cerebral Concussions• Observe and check:

– PEARL– Balance– Memory

• Retrograde Amnesia - can’t remember anything that occurred immediately before injury

• Anterograde Amnesia - can’t remember anything that occurred after injury

• Athlete must sit 15-20 minutes and then reevaluate

Cerebral Concussion

• Symptoms subside - they may return to activity - “mild head injury”

• Symptoms remain - they are out for the game or practice and must be cleared by a physician to return

• Any loss of consciousness (LOC) - keep athlete where they are, do not move and call 9-1-1

Cerebral Concussion

• Expected return to play:• Many different scales (clearance by

MD)– Grade I = one week asymptomatic– Grade 2 = clearance by a physician,

usually one to two weeks asymptomatic– Grade 3 = clearance by a neurologist,

usually one to three months or more depending on severity

Cerebral Concussion• Home care instructions

– Make sure parents/guardians know situation and what happened

– Make sure roommates or friends know and monitor

– Have someone watch for:

• Increasing headache

• Disorientation

• Vomiting

• Impairment of consciousness

• Unequal pupils

• Fluids from nose and ears

– If these appear, then get to MD or call 9-1-1

– Controversies:

• Sleep vs. no sleep: many MD’s recommend to let the athlete sleep so they can get rest but you should have someone check on them every couple of hours

• Medications: make sure athletes do not take anything because it will mask the symptoms

Post-Concussion Syndrome

• Post-concussion syndrome may appear for a variable amount of time following injury

• Athlete has problems with attention (especially trying to concentrate), anxiety, abnormal giddiness and headaches

Second Impact Syndrome

• Cause = due to rapid swelling and herniation of the brain after a second head injury

• S&S = within 15 sec - min, the condition worsens rapidly, dilated pupils, LOC

• Care = CALL 9-1-1

Facial Injuries

• Jaw fracture (mandible fx): 2nd incidence of all facial fractures

• Cause = blow to jaw - lower more common

• S&S = deformity, loss of occlusion of teeth, pain when biting, bleeding around teeth, numbness

• Care = cold packs and refer to ER or MD - rule out head injury. Full activity resumed in 2-3 months

Facial Injuries• Zygomatic (cheekbone fracture): Third most

common facial fracture

• Cause = blow to cheek

• S&S = deformity in cheek region, crackling (crepitus) when you push on cheek, nosebleed, diplopia

• Care = cold packs and referral - rule out head injury, healing usually takes 6-8wks

• Orbital hematoma (black eye)– Reduce inflammation (ice and

compression), check for concussion

• Orbital fracture (blowout fx)– Fracture of the bones that

surround the eye– S&S: restricted movement of

eye, diplopia (double vision), swelling, hemorrhage, numbness

– Management = ice, refer for xray

* If very painful, cover both eyes and transport in recumbant position (call 9-1-1)

• Skull fractureCause = direct trauma

S&S = severe headache, nausea, blood in ear canal, bleeding from nose

• Raccoon eyes = ecchymosis around eyes• Battle sign = ecchymosis behind the ears • Cerebrospinal fluid = straw colored fluid in nose or ear

Care = call 9-1-1, do not move athlete, monitor vitals and ABC’s

Facial Injuries

• Dental Trauma – Tooth Fracture = very sensitive and painful (nerve exposed)

- stop bleeding and if able athlete can return and see dentist after the game (24-48 hrs)

–

– Dislocated tooth = rinse tooth and place back in socket, keep in saline (salt water) or milk, store in tooth savor

• Need to see dentist within 30 minutes - refer immediately

Facial Injuries

• Nasal fracture: most common fracture of the face

• S&S = nose bleed, swelling, deformity, abnormal ability or crepitus

• Care = control bleeding, refer to physician

• Usually can play when symptoms

subside and proper protection

is maintained

Facial Injuries

Nosebleed:• How do I stop bleeding?

1. Ice

2. Have athlete lean forward and pinch bridge of nose

3. Place noseplug, gauze, or tissue up into nostril

4. Place skin lube or vaseline on noseplug to aid in clotting

5. Place a rolled piece of gauze under upper lip

Eye Injuries

• Corneal abrasion: foreign object usually rubbed - athlete complains of pain, watering and eye spasm that won’t subside - refer to eye physician

• Retinal detachment: painless, but athlete complains of seeing specks, flashes of light or blurred vision, usually lose part of visual field - immediate referral to eye physician