Head and Face Injuries 2007 PDF

Injuries to the Head, Face, Ears, Eyes, Nose, and Mouth © 2007 McGraw-Hill Higher Education. All rights reserved.  Anatomy Bones: creates the cranium/skull; houses the brain (thickness varies) – 22 bones with immovable joints. Scalp –...

Injuries to the Head, Face, Ears, Eyes, Nose, and Mouth © 2007 McGraw-Hill Higher Education. All rights reserved.  Anatomy Bones: creates the cranium/skull; houses the brain (thickness varies) – 22 bones with immovable joints. Scalp – 5 layers of soft tissue that covers the skull Brain: housed within the skull – Very important part on the central nervous system Eyes: – Socket, eyelids, eyebrows, cornea, pupil. Ears: 3 parts – External ear, middle ear, and internal ear Nose Mouth – Tongue, teeth, gums, cheek, jaw bones. © 2007 McGraw-Hill Higher Education. All rights reserved. © 2007 McGraw-Hill Higher Education. All rights reserved. Preventing Head and Face Injuries Injuries to the head and face are prevalent in all sports Protective equipment dramatically reduce the incidence of injuries to head, face, eyes, ears and nose – helmets, head gear, facemasks, protective goggles, mouth guards, etc.. Protect the soft tissues not necessarily the brain. © 2007 McGraw-Hill Higher Education. All rights reserved.  Injury Assessments of the Head and Face Priority First Aid for any head injury must always deal with any life-threatening conditions: – Loss of breathing – Loss of heart beat/pulse – Loss of consciousness (always assume cervical spine involvement) Activate EMS immediately. If no life threatening injury exists then history and further assessment can occur. © 2007 McGraw-Hill Higher Education. All rights reserved. Assessment Continued (History) Primary purpose of the history is to establish whether a person has sustained a concussion and to determine severity of the injury. Additional Questions: Where is your pain? Do you have neck pain? Can you move your hands/fingers and feet/toes? Do you know where you are and what happened? What is the score? Who are we playing? Can you remember walking off the field? © 2007 McGraw-Hill Higher Education. All rights reserved.  Observable Signs Was the person laying Is there slurred or altered motionless? speech? Was there difficulties with Are there any memory deficits? balance, gait, general Is there a normal emotional movements/coordination? response? Was there disorientation, Was there visible facial confusion or an inability to trauma? respond? Are they able to keep eyes open Was there a blank or vacant and obey commands? look? © 2007 McGraw-Hill Higher Education. All rights reserved. Recognizing and Managing Head Injuries © 2007 McGraw-Hill Higher Education. All rights reserved.  Concussions – Mild Traumatic Brain Injuries (MTBI’s) Injury to the Brain – Causes immediate and sometimes long lasting impairment of neurological function. May occur as a result of – Direct blow Coup injury: injury on same side of the brain as impact Contrecoup Injury: injury on opposite side of the brain as impact. – Acceleration/Deceleration forces (Whiplash affect) Sudden snapping of the head and neck in any direction. Not all traumatic brain injuries result in unconsciousness, disorientation, cognitive deficits, amnesia, loss of motor coordination, or balance issues. © 2007 McGraw-Hill Higher Education. All rights reserved.  MTBI’s Continued RED FLAGS – Neck pain – Double vision – Weakness or numbness/tingling/burning in extremities – Increasing severe headache – Seizure/convulsion – Loss of Consciousness – Deteriorating Conscious state – Vomiting – Increasingly restlessness, agitated, or combative. Amnesia may be present (2 Types) – Anterograde: Loss of memory from the time of injury and after. – Retrograde: Loss of memory from before the time of injury. © 2007 McGraw-Hill Higher Education. All rights reserved.  MTBI’s Continued Symptoms – May present immediately or may not present for up to 24 hours later. Can be physical – Headaches, pressure in head, sensitivity to light, sensitivity to sound, dizziness, nausea, Can be Emotional – Feel more emotions, sadness, nervousness, irritability Can be Cognitive – Attention difficulty, memory dysfunction, fogginess, fatigue, feeling slowed down Can be Sleep Disturbances – Difficulty falling asleep, difficulty staying asleep, sleeping more than normal, sleeping less than normal. © 2007 McGraw-Hill Higher Education. All rights reserved.  Concussion Assessment Both subjective (symptoms) and objective measures should be used to assess for a concussion BUT even one symptom is enough to signal athlete may be concussed – NCAA Regulations dictate that at any point if/when someone reports concussion like symptoms, removal from activity for further evaluation is necessary. © 2007 McGraw-Hill Higher Education. All rights reserved.  Concussion Assessment Cognitive Tests – Used to establish impact of head trauma on cognitive function and to obtain objective measures to assess patient status and improvement – SCAT Sport Concussion Assessment Tool (SCAT) provides immediate objective data concerning presence and severity of neurocognitive impairment – Orientation, Immediate Memory, Concentration, and Delayed Recall. © 2007 McGraw-Hill Higher Education. All rights reserved.  Special Testing SCAT6 – Cognitive assessment testing – Eye Function testing PERRLA: Pupils Equal, Round and Reactive to Light and Accomodation – Assessing for irregular shape or size – Ability to accommodate to light and movement – Balance Testing mBESS Test – Coordination Testing Finger to nose Tandem walking – CRT6 (Concussion Recognition Tool) is a tool developed alongside the SCAT6 to help coaches recognize concussion, and refer athletes to appropriate medical personnel © 2007 McGraw-Hill Higher Education. All rights reserved.  Concussion Assessment BESS Test – http://www.youtube.com/watc h?v=BhPAwozGwjc – Assess static balance to determine individual’s ability to stand and remain motionless – Double leg stance – Single leg stance – Tandem stance – 20 second trials of each, count # of errors © 2007 McGraw-Hill Higher Education. All rights reserved.  Concussion Assessment Cognitive Tests (con.) – ImPACT test Immediate post-concussion assessment and cognitive test Computerized concussion evaluation system ~30 minute test Measures verbal and visual memory, processing speed, reaction time, and symptoms Example activities – symbol matching, colour matching, three letter work memory Provides a summary comparing the individuals scores to their baseline results and/or established norms © 2007 McGraw-Hill Higher Education. All rights reserved. ImPACT © 2007 McGraw-Hill Higher Education. All rights reserved.  Immediate Care Any suspected concussion results in removal from activity. You can allow them to return to their dorm/home with responsible caretaker to rest – Allow them to sleep (rest is best) No need to wake them up to check on them. – instructions on Red Flags should be given to responsible caretaker. – Instruction to meet a health care provider for further/continued evaluation 24 hours of ALL physical and cognitive rest is generally advised. – Recurrent concussive event may produce Second-Impact Syndrome or Post Concussion Syndrome © 2007 McGraw-Hill Higher Education. All rights reserved.  Long Term Care Continued check-ins on regular basis with athletic trainer or medical professional. – Symptom evaluations. Temporary removal from classes may be necessary. Activity level is symptom limited. Before full return to participation concussion symptoms must be returned to baseline levels. – Must progress through a gradual return to play process Recurrent Concussions – Severity and duration of functional impairment may be greater. – Chances of a second concussion are 3-6X greater than someone who has never sustained a concussion. © 2007 McGraw-Hill Higher Education. All rights reserved.  Post-Concussion Syndrome Condition where concussion-like symptoms persist for months, years. Not associated with severity of initial injury Signs – Complaints of range of concussion-like symptoms. Care – Treat symptoms. – Referral to physician. Return to Play only when all signs/symptoms resolve. © 2007 McGraw-Hill Higher Education. All rights reserved.  Second Impact Syndrome Rapid Swelling of the brain after a second concussive force before symptoms from initial injury have resolved. The injury may be relative minimal and not actually involve contact to the head. This injury disrupts the brain’s autoregulatory system – Leads to swelling, increasing intracranial pressure Signs – Usually degrading condition Dilated pupils, loss of eye movement, loss of consciousness, respiratory failure © 2007 McGraw-Hill Higher Education. All rights reserved.  Second Impact Syndrome Continued Life Threatening injury that must be addressed with life saving measures immediately. Best management is prevention – NEVER return an athlete to play when experiencing concussion-like symptoms. © 2007 McGraw-Hill Higher Education. All rights reserved.  Chronic Traumatic Encephalopathy (CTE) Progressive degenerative disease of the brain – Found in individuals with history of repetitive brain trauma Multiple concussions or repetitive sub-concussive blows Causes changes in brain tissue Can lead to memory loss, confusion, depression, impaired judgement, aggression, and dementia. Diagnosed by looking at the brain (Post-Mortem) © 2007 McGraw-Hill Higher Education. All rights reserved.  CTE Continued Education – Players and coaches Equipment – Properly fitted and that they actually wear the protective equipment Technique – Body checking, tackling Rule changes © 2007 McGraw-Hill Higher Education. All rights reserved.  Skull Fracture Cause of Injury – Most common cause is blunt trauma Signs of Injury – Severe headache and nausea – May be blood in the middle ear, ear canal, nose, ecchymosis around the eyes (raccoon eyes) or behind the ear (Battle’s sign) Care – Immediate hospitalization and referral to neurosurgeon © 2007 McGraw-Hill Higher Education. All rights reserved.  Epidural Hematoma Cause of Injury – Blow to head or skull fracture which tear arteries – Blood pressure, blood accumulation and creation of hematoma occurs rapidly (minutes to hours) © 2007 McGraw-Hill Higher Education. All rights reserved.  Epidural Hematoma Signs of Injury – Loss of consciousness followed by period of consciousness, showing few signs and symptoms of serious head injury – Gradual progression of S&S Headache, dizziness, nausea, dilation of one pupil (same side as injury), deterioration of consciousness, neck rigidity, depression of pulse and respiration, and convulsion Care – Requires urgent neurosurgical care – Must relieve pressure to avoid disability or death © 2007 McGraw-Hill Higher Education. All rights reserved. © 2007 McGraw-Hill Higher Education. All rights reserved.  Subdural Hematoma Result of acceleration/deceleration forces that tear vessels that bridge dura mater and brain Venous bleeding (simple hematoma may result in little to no damage to cerebellum while more complicated bleed can damage cortex) © 2007 McGraw-Hill Higher Education. All rights reserved.  Subdural Hematoma Signs of Injury – Athlete may experience loss of consciousness, dilation of one pupil – Signs of headache, dizziness, nausea or sleepiness Care – Immediate medical attention – CT or MRI is necessary to determine extent of injury © 2007 McGraw-Hill Higher Education. All rights reserved. Recognizing and Managing Facial Injuries © 2007 McGraw-Hill Higher Education. All rights reserved.  Facial Fractures Cause of Injury – Usually from a direct blow Signs of Injury – Deformity, pain with biting, bleeding around teeth, jaw doesn’t line up Care – Immobilize if you can – Refer to physician/ER © 2007 McGraw-Hill Higher Education. All rights reserved.  Types of Facial Fractures Mandible Fracture – Usually breaks at the front angle – Try and wrap around the head to splint it Cheekbone Fracture – Can get nosebleed with it Nasal Fracture – immediate swelling and deformity – Control bleeding © 2007 McGraw-Hill Higher Education. All rights reserved.  Nosebleed (epistaxis) Result of a direct blow, a sinus infection, high humidity, allergies, a foreign body or some other serious facial injury Signs of Injury – Generally bleeding from anterior aspect of the septum – Generally presents with minimal bleeding and resolves spontaneously – More severe bleeding may require more medical attention © 2007 McGraw-Hill Higher Education. All rights reserved.  Nosebleed (epistaxis) Care – sit upright, place cold compress over the nose, pressure on the affected nostril Gauze between the upper lip and gum - limits blood supply – If bleeding does not cease in 5 minutes, a gauze/cotton nose plug to encourage clotting should be utilized – After bleeding has ceased, the athlete can return to play recommend not to blow the nose for at least 2 hours after the initial insult © 2007 McGraw-Hill Higher Education. All rights reserved. Recognizing and Managing Dental Injuries © 2007 McGraw-Hill Higher Education. All rights reserved.  Prevention of Dental Injuries When engaged in contact/collision sports mouth guards should be routinely worn – Greatly reduces the incidence of oral injuries Practice good dental hygiene Dental screenings should occur yearly – Cavity prevention – Prevention of abscess development, gingivitis, and periodontitis © 2007 McGraw-Hill Higher Education. All rights reserved.  Tooth Fractures Cause of Injury – Impact to the jaw, direct trauma Signs of Injury – Tooth fragments with or without bleeding – Pain © 2007 McGraw-Hill Higher Education. All rights reserved.  Tooth Fractures Care – Do not require immediate attention Fractured pieces can be placed in a bag and and if not sensitive to air or cold, follow-up can wait for 24-48 hours Bleeding can be controlled via gauze – Athlete can continue to play but must follow-up immediately following competition – Tooth repositioning may be required, along with bracing and the use of mouthpieces in the future © 2007 McGraw-Hill Higher Education. All rights reserved.  Tooth Subluxation, Luxation, and Avulsion Caused by direct blow Signs of Injury – Subluxed tooth – loose within the socket – Luxation – tooth is loose and has moved either forwards or backwards Tooth may be slightly loosened, dislodged – Avulsion – tooth knocked out of oral cavity Care – Referral to dentist – Use a Save a Tooth Kit, milk or saline © 2007 McGraw-Hill Higher Education. All rights reserved. Recognizing and Managing Ear Injuries © 2007 McGraw-Hill Higher Education. All rights reserved.  Auricular Hematoma (Cauliflower ear) Occurs either from compression or shear injury to the ear (single or repeated) – Causes subcutaneous bleeding Signs of Injury – Tearing of overlying tissue away from cartilage – Hemorrhaging and fluid accumulation If unattended - coagulation, organization and fibrosis occurs – Appears as elevated, white, rounded nodular formation, that is firm and resembles cauliflower © 2007 McGraw-Hill Higher Education. All rights reserved.  Auricular Hematoma (Cauliflower ear) Care – To prevent, wear proper ear protection – Ice will minimize hemorrhaging – If swelling occurs, need to prevent fluid solidification Physician aspiration © 2007 McGraw-Hill Higher Education. All rights reserved.  Tympanic Membrane Rupture Cause of Injury – Fall or slap to the unprotected ear or sudden underwater variation can result in a rupture Signs of Injury – Complaint of loud pop, followed by pain in ear, nausea, vomiting, and dizziness – Hearing loss, visible rupture (seen through otoscope) Care – Small to moderate perforations usually heal spontaneously in 1-2 weeks – Infection can occur and must be continually monitored – Should not fly until condition is resolved © 2007 McGraw-Hill Higher Education. All rights reserved. Swimmer’s Ear (Otitis Externa) – Cause of Injury Infection of the ear canal caused be a gram-negative bacillus Water becomes trapped by a cyst, bone growths, earwax plugs or swelling caused by allergies – Signs of Injury Pain and dizziness, itching, discharge and even partial hearing loss – Care Prevention – drying ear with a soft towel, use ear drops with boric acid and alcohol before and after swimming – Avoid things that might cause infection; overexposure to cold wind or sticking foreign objects into the ear Physician referral will be necessary for antibiotics, and to rule out tympanic membrane rupture © 2007 McGraw-Hill Higher Education. All rights reserved. Recognizing and Managing Eye Injuries © 2007 McGraw-Hill Higher Education. All rights reserved.  Black Eye Orbital Hematoma Cause – Blow to the area surrounding the eye which results in capillary bleeding Signs of Injury – Swelling and discoloration Care – Ice – Remove from play if athlete has distorted vision – Do not blow nose after acute eye injury – may increase hemorrhaging © 2007 McGraw-Hill Higher Education. All rights reserved. © 2007 McGraw-Hill Higher Education. All rights reserved.  Orbital Fracture Cause – Blow to the eye area can force eyeball posteriorly, compressing the orbital fat until a blowout rupture occurs to the floor of the orbit bone Signs of Injury – Diplopia, restricted eye movement, downward displacement of the eye, soft-tissue swelling and hemorrhaging – Numbness if infraorbital nerve injured Care – X-ray will be necessary to confirm fracture – Antibiotics to decrease risk of infection (due to proximity of maxillary sinus and bacteria) – Treat surgically or allow to resolve spontaneously © 2007 McGraw-Hill Higher Education. All rights reserved.  Corneal Abrasions Cause – Attempted removal of foreign object from eye by rubbing Signs of Injury – Severe pain, watering of the eye, photophobia, and spasm of the orbicular muscle of the eyelid Care – Patch eye and refer to a physician © 2007 McGraw-Hill Higher Education. All rights reserved.  Hyphema Bleeding in the anterior chamber of the eye. Located between the iris and cornea. Can lead to serious problems with lens or retina Cause – Direct impact to the eye Signs of Injury – Blood collects in anterior chamber of the eye – Visible reddish tinge in anterior chamber (may turn pea green) – Partially or completely blocked vision Care – Referral – Bed rest and elevation (30-40 degrees – Both eyes patched – Sedation – medication © 2007 McGraw-Hill Higher Education. All rights reserved.  Retinal Detachment Cause – Blow to the eye partially or completely separating the retina from the underlying retinal pigment epithelium Signs of Injury – Painless, early signs include specks floating before the eye, flashes of light, or blurred vision – As it progresses, “curtain falling” over the field of vision occurs Care – Immediate referral to an ophthalmologist – Bed rest, patches for both eyes © 2007 McGraw-Hill Higher Education. All rights reserved.  Conjunctivitis (Pinkeye) Cause of Injury – Caused by bacteria or allergens – Conjunctival irritation caused by wind, dust, smoke, or air pollution – Associated with colds or upper respiratory conditions Signs of Injury – Eyelid swelling w/ purulent discharge; itching associated with an allergy; burning or itching Care – Highly infectious – Refer to physician for treatment © 2007 McGraw-Hill Higher Education. All rights reserved.