Head Injuries
Objectives
 Describe
the anatomy of the head
 Understand that head injuries can be
prevented
 Understand the urgency involved with
caring for brain injuries
 Describe the numerous types of head
injuries
VERY IMPORTANT!!!!
 ATC
must act quickly to lessen the
chance of death and permanent injury.
 Any head injury must be taken seriously.
 Better safe than sorry!
Anatomy of the head
 Skull
is composed of 28 bones
 Skull protects the brain
 A suture line is where two bones in the
skull come together
 The only moveable bone in the skull is the
mandible (lower jaw).
The Brain
 Made
up of billions of cells
 Weighs about 3 pounds
 Requires 20% of the total body oxygen
 Requires 15% of the blood supply
 Brain cells grow and develop until age 18

After 18, brain cells can be destroyed and
not reproduced
How important is oxygen to
the brain?
 Depriving
oxygen to the brain will cause
unconsciousness and then death


Pupils dilate within 60 seconds
After 4-6 minutes: biological brain death
occurs
 Large
number of cells are dying
Lobes of the brain
 Brain
is divided into lobes
 Each lobe is named after the bony
structure of the skull that it covers
 4 lobes: occipital, temporal, parietal, and
frontal
 Each lobe is responsible for specific body
functions
 Traumatic Brain Injuries: Effects of damage
to different lobes of the brain - YouTube
Brain Areas and Functions
 Frontal
lobe: voluntary muscle
movements, emotion, and eye
movements
 Parietal lobe: sensation
 Occipital lobe: vision
 Temporal lobe: hearing, speech
 Cerebellum: equilibrium, muscle actions,
some reflexes
The Brain
 Attaches
to the spinal cord at the brain
stem via a crossover

Right side of the brain controls the left side
of the body and vice versa
 Preserving
brain function is of utmost
importance
 Athlete’s quality of life and his degree of
recovery depends on how a brain injury is
handled
Cerebrospinal fluid
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Bathes the brain and spinal cord in chemicals
for proper functioning, helps maintain regular
pressure around the brain and spinal cord,
and protects the brain from impact
Clear amber in color
May drain from an opening in the skull, nose,
or ear when a severe head injury occurs
Allow this fluid to drain; stopping the drainage
will increase the pressure within the skull and
cause more brain damage.
The Scalp
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Part of the skin that covers the skull
Contains a large number of blood vessels,
muscles, and hair
Skin protects against infection
Hair protects the skin from the sun and helps
keep dirt and sweat away from the eyes
Blood vessels are so numerous that even a
small cut can bleed profusely
A blow to the head can cause many blood
vessels to break open and bleed under the
skin-causes a lump called a hematoma
The Scalp

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Has the ability to decrease the force of an
impact to the skull due to additional padding
(however small) it provides and the increased
elasticity created by the tension of the
connective tissue between the scalp and skull
Believed that without the scalp, the skull
could be fractured with as little as 40 lbs of
pressure.
With the scalp, it may take 425 lbs of pressure
to fracture the skull
Preventing Head Injuries
 Head
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injuries prevented by:
helmets
mouth guards
rules
common sense
Mouth Guards


The unsung hero of preventing head injuries
(along with protecting your teeth)
Provide spacing and shock absorption
between mandible and maxilla (prevents the
shock from being transmitted to the brain
stem)


Impact to the chin drives the mandible into the
maxilla and causes the brain stem to twist
slightly, which results in unconsciousness
Must be fitted and in good condition to be
effective
Helmets
 Properly
fitted helmets help protect the
athlete’s head from direct impact
 Face masks protect the face
 Spearing-use of the head to make
contact with another player


Resulted in numerous neck injuries that
resulted in permanent injuries or death
Illegal, results in a penalty usually severe
enough to get ejected from the game
Skills and Rules
 Athletes
need to be taught the proper
skills and rules in order to prevent injuries
 Coaches should take the time to teach
proper safety skills and should
communicate with ATC when this will take
place
 Coaches or ATC should also explain the
signs and symptoms of head injuries to
athletes
What can coaches do to
prevent/recognize head
injuries?
Head Injury Mechanisms

Injuries can be caused by impact or rotations
of the head
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Most commonly caused by impact
Region most susceptible to injury is the
temporal region (bone is the thinnest here)
Contrecoup-injury occurs when the head is
moving and receives a blow


Upon impact, brain sloshes to the opposite side
of the skull and stops when it impacts the side of
the skull
Athlete complains of a headache opposite of
the impact
Head Injury Mechanisms
 Rotations
of the head after an initial
impact can cause the brain stem to stop
functioning normally
 Nerve receptors are overloaded with
information to the brain
 Brain overload causes unconsciousness

This allows for a sorting of the impulses
Treating Head Injuries
 Potentially

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
life-threatening head injuries:
Skull fractures
Concussions
Intracranial hematomas
Skull Fractures

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Occur when there is a significant force
against the head
Several types of fractures:
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Depressed-pushes a portion of the skull inside
toward brain
Linear-goes across skull
Compound-portion of skull sticking through
scalp
Penetrating-object has gone through scalp,
skull, and likely the brain
Skull Fractures
 Will

discolor the area behind the ear
Called a battle sign
**Requires immediate attention of a
physician
Concussion
 Temporary
impairment of brain function
caused by impact to the head or by a
rotation force
 Sends a sudden massive number of
impulses to the brain
 Brain becomes overwhelmed-athlete may
be confused, dazed, or even lose
consciousness
Symptoms of Concussions
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Confused/dazed
Nausea or vomitting
Dizziness
Headache
Tinnitus-ringing in ears
Loss of balance
Amnesia-difficulty remembering things before
or after impact
Disorientation
Concussion Grading
 Mild
(1st degree)-no loss of consciousness
and athlete symptoms/abnormalities
resolve in less than 15 minutes
 Moderate (2nd degree)-no loss of
consciousness but athlete
symptoms/abnormalities last longer than
15 minutes
Concussion Grading

Severe (3rd degree)-any loss of consciousness
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Rapid eye movement
Pupils may be unequal in size (pupil on side of
injury is usually bigger)
May be in a coma but can hear what people
are saying
Increase in BP
Decrease in pulse rate
Signs of shock
Possible neck injury may have occurred
Intracranial Hematoma
 Severe
bleeding within the brain caused
by a blow to the head
 Causes significant increase in pressure on
the brain
 Rapid death can occur
 If athlete is found in a coma, chances of
survival are 40%
 Survival depends on early examination by
a physician and prompt surgical care
Intracranial Hematoma
 Typically
a hole is drilled in the skull to
allow drainage of blood and attempt to
repair the bleeding vessel
 If athlete is not in a coma, physician will
put them in a coma
 Comatose state helps keep the athlete
calm and allows the brain to heal without
movement
Symptoms of Intracranial
Hematoma
 Headaches
 Nausea/vomiting
 Loss
of consciousness
 Paralysis of extremities on opposite side of
injury
 Battle sign
Signs of a Hematoma
Rise in BP
 Drop in pulse
 Pupil on same side of injury is enlarged
 Difficulty speaking
 Rapid eye movements
 Unconsciousness or coma
 Lack of coordination
 Difficulty using extremities side opposite of
hematoma
**athlete may fully recover, suffer permanent brain
impairment, or die

Post-concussion Syndrome
 Persistence
of symptoms
 May include headache, ringing in the
ears, dizziness, or confusion
 Should be seen by a physician
 Usually doesn’t last more than a week or
two
Second-Impact Syndrome
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Damage from concussions and brain injuries are
cumulative in nature
If athlete returns to sport before symptoms of first
concussion have completed subsided and he
receives another blow to the head, can quickly
lose brain function and go into a coma
Second-impact can disturb the brain’s blood
supply and present signs of a minor concussion
followed by a semicomatose state
Athletes must be symptom free and clearance
from a doctor before returning to play
SESD Gradual Return to Play
 Athlete
must be symptom free for 24 hours
prior to taking the ImPACT
 If athlete passes ImPACT, begin 5-day
gradual return to play
 Day 1: 20 minute walk
 Day 2: 20 minute jog
 Day 3: Sport specific activity (no contact)
 Day 4: Controlled contact
 Day 5: Full participation