head and facial conditions - davis.k12.ut.us causes an increase in intracranial ... transient...
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Anatomy of Head and Face (cont.)
Ear
Major areas
Outer ear (auricle and external auditory canal)
Middle ear (tympanic membrane)
Inner ear (labyrinth)
Anatomy of the head & neck - Muscles
Muscle Location Function
Sternocleidomastoid
(SCM)
Anterior aspect of the
neck
Flex neck; rotate the
head
Trapezius Posterior aspect of the
neck
Extends neck; adducts
scapula
Anatomy of Head and Face (cont.)
Vertebrae
7 cervical
12 thoracic
5 lumbar
Intervertebral Discs
Concussions
Football
Softball
Basketball
PREVENTION
Protective Equipment is crucial
Must be in good, working condition
Must be used properly
Must fit the athlete properly
Examples: helmet, face guard, and mouth guard
Cerebral Conditions
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!!!!!!
Mechanisms
Direct impact causes two conditions
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
Concussion Animation
Impact causes Acceleration
Shock waves pass through skull to brain
Causes acceleration
Leads to :
tensile forces :
compressive forces :
shear forces :
Concussions
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!
Amnesia
Post Traumatic Amnesia (PTA)
Definition = the inability to recall events that have occurred since the time of injury.
Retrograde Amnesia (RA)
Definition = the inability to remember events that occurred before the injury
Second Impact Syndrome
An athlete sustains a 2nd head injury before the symptoms associated with a previous head injury have cleared.
This causes an increase in intracranial pressure.
Leads to respiratory arrest or death.
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
(( ))
Assessment of Concussions Palpate the neck: look for any deformities
or painful areas
Orientation x 4 : who are they, where are they, what happened, and when????
Move down body w/ symptoms
Head
Neck
Muscles
Stomach
Function
Assessment of Concussions
Pulse
Blood Pressure
Respirations
Reflexes
Dermatomes
Myotomes
Rhomberg Test
1. Olfactory Smell
2. Optic Sight
3. Occulomotor Eye Movement
4. Trochlear Eye Movement
5. Trigeminal Facial Motion/ Sensation
6. Abducens Eye Movement
7. Facial Facial Expression/ Sensation
8. Vestibulochochlear Hearing and Balance
9. Glossopharengeal Tongue and Throat
10.Vagus Digestion/ Excretion
11.Accessory Head, Neck, Shoulder muscles
12.Hypoglossal Speech, Swallowing
Immediate Memory
• 3 Words
Concentration
• Months in reverse order
• Delayed Word Recall
Exertion Maneuver
• Jumping jacks, Sit ups, Push ups, Squats
Neurological Screening
• Loss of Consciousness – Y / N if yes how long?
• Pre- & Post- Amnesia
• Strength
Coordination
• Finger to Nose
• Straight line test: can they walk the line?
Assessment of Concussions
CONCUSSION
GRADE SIGNS & SYMPTOMS MANAGEMENT
GRADE 1
Transient confusion
<30 min
NO loss of
consciousness
All symptoms gone in
< 24 hours
Remove from activity
Examine immediately
Re-examine at 5-10 minute intervals
If asymptomatic, stress test
May return to play if symptoms
resolve in < 15 mins.
GRADE 2
Transient confusion
> 30 min < 24 hours
loss of consciousness
less than 1 minute
Symptoms last > 24
hours and less than 7
days.
Remove from activity
Examine immediately
Re-examine at 5-10 minute intervals
Disallow return that day
May refer to ER for further testing
(i.e., CT scan)
Re-evaluate the following day
May return to play after 1 week of
being asymptomatic at rest & stress
CONCUSSION
GRADE SIGNS & SYMPTOMS MANAGEMENT
GRADE 3
Any loss of
consciousness >1
minute
Transient confusion
> 24 hours
Symptoms > 7 days
Remove from activity
Examine immediately
Refer to ER for further testing (i.e.,
CT scan)
Generally, out of activity for 1 month
once asymptomatic
RETURN TO ACTIVITY IS NOT ALLOWED UNTIL ALL
SYMPTOMS HAVE RESOLVED AT REST AND UNDER
STRESS.
Post Concussive Syndrome
Persistent symptoms following concussion
Persistent headache
Impaired memory
Lack of concentration
Anxiety
Irritability
Fatigue
Depression
Visual disturbances
Athlete should not return to play until all symptoms have resolved
Prevention of Head and Facial Injuries
Protective equipment
Helmets
Face guards
Mouth guards
Eye wear
Ear wear
Throat protectors
Scalp Injuries
Highly vascularized; bleeds freely
Laceration Control bleeding
Prevent contamination
Assess for skull fracture (fx)
Management: If no fx, cleanse, cover, and refer
Abrasions and contusions Cleanse; ice and pressure
24 hours: no improvement – refer
Cranial Injury Mechanisms
Injury dependent on:
Material properties of skull
Thickness of skull
Magnitude and direction of force
Size of impact area
Bone deforms and bends inward
Inner border – tensile strain
Outer border – compressed
Skull Fracture (cont.)
Potential for varying signs and symptoms (S&S)
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.)
Bleeding or CSF from nose and/or ear
Battle Sign
Raccoon Eye’s
“Halo” Sign
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
Facial soft tissue conditions
Contusions, abrasions, and lacerations are managed the same as elsewhere on the body
Complicated injuries—immediate physician referral
Facial Conditions (cont.)
Fractures
Zygomatic
S&S: cheek appears flat or depressed, double vision, numbness in affected cheek
Management: ice, immediate referral
Mandibular
Common: mandibular angle and condyles
S&S: malocclusion, changes in speech, oral bleeding, + tongue blade
Management: ice, immediate referral
Facial Conditions (cont.)
Maxillary
LeFort fx (upper jaw)
S&S: appearance of longer face, nasal bleeding, malocclusion, nasal deformity, ecchymosis
Management: ice, immediate referral
Facial “red flags”
Nasal Conditions
Epistaxis (nose bleed) 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 S&S
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.)
Fractures
Most common: lateral displacement
Range of severity varies
S&S
Asymmetry – especially with lateral force
Epistaxis
Crepitus
Management: control bleeding; refer
Nasal “red flags”
Oral and Dental Conditions
Mouth lacerations
Minor lacerations are the same as in other lacerations
Lip and tongue lacerations: require special suturing
Loose teeth
Displaced outward or lateral: attempt to place back in normal position
Intruded: immediate referral to dentist
Oral and Dental Conditions (cont.)
Fractured tooth
Enamel: no symptoms
Dentin: pain and increased sensitivity to heat and cold
Pulp or root: severe pain and sensitivity
Management: refer to dentist
Oral and Dental Conditions (cont.)
Dislocated tooth
Time is of the essence; refer
Hold tooth by crown
Do not rub the tooth or remove any dirt; milk or saline
Oral and dental “red flags”
Ear Conditions
Cauliflower ear (auricular hematoma)
Repeated trauma pulls cartilage away from perichondrium – hematoma forms
Untreated – forms a fibrosis
Management: ice; possible aspiration by physician
Key is prevention!
Impacted cerumen (wax)
Possible hearing loss or muffled hearing
Management: irrigate canal with warm water
Ear Conditions (cont.)
Otitis externa (swimmer’s ear)
Bacterial infection to lining of external auditory canal
S&S: pain, itching
Management: ear drops, custom ear plugs
Otitis media
Middle ear infection due to bacteria or virus
S&S: earache, hearing difficulty, possible serous otitis
Management: physician referral
Ear Conditions (cont.)
Tympanic membrane rupture
Caused by:
Infection
Direct trauma
Changes in pressure
Loud, sudden noises
Foreign objects in the ear
Ear Conditions (cont.)
S&S Very painful
Tinnitus
Pus-filled or bloody drainage from the ear
Sudden decrease in ear pain followed by drainage
Hearing loss
Management: physician referral
Ear “red flags”
Eye Conditions
Preorbital ecchymosis (black eye)
Assessment
Management: ice, referral to ophthalmologist
Foreign bodies
S&S: intense pain, tearing
Management
Not embedded: removal, inspection
Embedded: do not touch, activate EMS
Eye Conditions (cont.)
Orbital “blowout” fracture Impact from a blunt object, usually larger than the
eye orbit
S&S: Diplopia
Numbness below eye
Lack of eye movement
Recessed downward displacement of globe
Management: ice; immediate referral to physician
Eye “red flags”
Cervical Spine
Fracture
S&S
Pain
Numbness
Tingling
Management
Spinal immobilization
Refer to a physician