Injuries to the Head, Neck &
Spine
Cerebral Conditions
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Impact or injuries causes bleeding within
the brain called HEMATOMAS
Artery damaged: quick decline in mental
status and functioning of the brain (10 –
20 minutes)
Vein damaged: slower onset (24 to 72
hours), slower bleeding and swelling
Both are life-threatening!!!!!!
Concussions
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Definition = the temporary impairment of brain
function caused by impact to the head, or
rotational force
Usually caused by a direct hit to the head, plus
the injury to the opposite side of the brain
where the brain bounces off of the skull.
The more concussions you sustain, the more
severe they become, and the easier it is to get
one!
Concussions
Football
Softball
Basketball
Mechanisms
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Direct impact causes two conditions
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1. deformation
2. acceleration
Direct blow can cause fracture at the site
of impact
Direct blow can cause fracture at site
away from area of impact
Signs and Symptoms
Dizziness
 Headache
 Excessive Drowsiness
 Unable to focus or concentrate
»Irritable and Confused
» Convulsions
* Nystagmus
*Visual problems
- Bleeding from nose or ears
-Tinnitus (ringing in ears)
~Paralysis
~Weakness in limbs or face
∞Memory problems
∞Balance problems
Nausea
Vomiting
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Concussions
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Treatment:
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Careful removal from play
Thorough physical and
neurological examination
Refer to physician for
follow-up examination
Assessment of Concussions
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Concussions
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Assessment:
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Neuropsychological Testing
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If possible, preseason testing on a computerized system
(ImPACT).
If a concussion occurs, retest injured athlete following
recommended protocols.
Thorough evaluation of athlete:
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(Sport Concussion Assessment Tool (SCAT 2) is a tool that
can be used to evaluate a concussed athlete.
Physical Examination – evaluation of athletes physical
symptoms as listed previously.
Assessment of Concussions
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Concussions
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Assessment
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Cognitive testing
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Immediate memory testing
 What month is it?
 What time is it?, etc.
Concentration
 Months of year backward
 100-7, continue backward
Delayed Recall – have athlete remember words, repeat at
later time
Assessment of Concussions
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Concussions
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Assessment
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Balance/Coordination testing
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Balance Error Scoring System (BESS)
Romberg Test
Finger to Nose
Common Injuries – Head/Neck
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Return to Play Guidelines:
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Depends on the level of play of the
athlete involved. Currently, the NCAA,
UHSAA, and a new Utah State law
regarding youth sports (HB 204) will
dictate a specific plan for concussion
management and return to play
guidelines. It will include some
variation of the following :
 Progression through Return-To-Play
stages on a case by case basis with
final clearance by an approved,
licensed health care professional:
Common Injuries – Head/Neck
Common Injuries – Head/Neck
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Second Impact Syndrome
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Rapid swelling of the brain from
additional head trauma; life
threatening
Second impact could be minor
Could be caused by blow to chest
that accelerates head.
Signs and Symptoms
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No initial loss of consciousness
Rapid worsening leading to:
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LOC progressing to coma
Dilated pupils
Loss of eye movement
Respiratory failure
Treatment: Immediate transport to
medical facility
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Prevention
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DO NOT LET THIS SITUATION
OCCUR!
Careful decision making regarding
return to play following initial head
trauma
Common Injuries – Head/Neck
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Post-Concussion Syndrome
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Persistent symptoms following concussion May begin immediately following injury and
may last for weeks to months
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Persistent headache
Impaired memory
Lack of concentration
Anxiety
Irritability
Fatigue
Depression
Continued visual disturbances
Treatment – No clear guidelines
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Treat symptoms to greatest extent
possible
Return athlete to play when all signs
and symptoms have fully resolved
ESPN Concussions
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OTL: College Football Concussions
Scalp Injuries
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Highly vascularized; bleeds freely
Laceration
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Control bleeding
Prevent contamination
Assess for skull fracture (fx)
Management:
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If no fx, cleanse, cover, and refer
Abrasions and contusions
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Cleanse; ice and pressure
24 hours: no improvement – refer
Skull Fracture
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Types
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Linear
Comminuted
Depressed
Basilar
Skull Fracture (cont.)
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Potential for varying signs and symptoms
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Visible deformity–do not be misled by a
“goose egg”; a fracture may be under the site
Deep laceration or severe bruise to scalp
Palpable depression or crepitus
Unequal pupils
Raccoon eyes or Battle’s sign
Skull Fracture (cont.)
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Bleeding or CSF from nose and/or ear
Battle Sign
 Raccoon Eye’s
 “Halo” Sign
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Loss of smell
Loss of sight or major vision disturbances
Unconsciousness 2 minutes after direct
trauma to the head
Management: activation of EMS
Facial Conditions
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Facial soft tissue conditions
Contusions, abrasions, and
lacerations are managed the
same as elsewhere on the body
 Complicated injuries—immediate
physician referral
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Nasal Conditions
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Epistaxis (nose bleed)
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Anterior – bleeding from anterior septum
Posterior – bleeding from lateral wall
Management: ice, mild pressure, slight forward head tilt;
nasal plug; 5 minutes – physician referral
Deviated septum
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S&S
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Consistent difference in airflow between the 2 sides of the nose when
one nostril is blocked
Confirm using otoscope
Management: physician referral
Nasal Conditions (cont.)
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Fractures
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Most common: lateral displacement
Range of severity varies
S&S
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Asymmetry – especially with lateral force
Epistaxis
Crepitus
Management: control bleeding; refer
Ear Conditions
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Cauliflower ear (auricular hematoma)
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Repeated trauma
Untreated – forms a fibrosis
Management: ice; possible aspiration by physician
Key is prevention
Eye Conditions
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Preorbital ecchymosis (black eye)
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Assessment
Management: ice, referral to ophthalmologist
Foreign bodies
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S&S: intense pain, tearing
Management
Not embedded: removal, inspection
 Embedded: do not touch, activate EMS
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Eye Conditions (cont.)
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Orbital “blowout” fracture
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Impact from a blunt object, usually larger than the
eye orbit
S&S:
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Diplopia
Numbness below eye
Lack of eye movement
Recessed downward displacement of globe
Management: ice; immediate referral to physician
Cervical Spine
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Fracture
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S&S
Pain
 Numbness
 Tingling
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Management
Spinal immobilization
 Refer to a physician
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Brachial Plexus
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31 pairs of spinal nerves
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“Stinger”
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Brachial C5-T1
Numbness
Loss of function
Management
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Remove from play
Allow RTP once
symptoms resolve
Guess the Injury!
Ouch…that hurts!
DIRECTIONS:
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For each of the following slides, try to
identify the type of injury that has
occurred.
Write your answer on your paper.
#1
#2
#3
#4
#5
#6
#7
#8
#9
#10
Answers
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Concussion
Scalp Laceration
Battle Sign
Deviated Septum
Foreign object
Preorbital Ecchymosis (Black Eye)
Epistaxis (nose bleed)
Cauliflower Ear
Orbital Fracture
Brachial Plexues