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