Concussion management Flashcards by Alexander Lee

ABI vs TBI

TBI is a type of ABI.

ABI is anything not hereditary, congenital, degenerative, or induced by birth trauma

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Mild brain injury classification

Normal imaging

Loss of consciousness 0-30 mins

Alteration of consciousness up to 24 hours

PTA 0-1 day

Glassgow coma score 13-15

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Do you need to have loss of consciousness for it to be a Mild TBI?

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Moderate TBI

GCS 9-12

PTA: 24hours to 7 days

Loss of consciousness 30 mins to 24 hours

some imaging findings

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What is the most common symptom of a concussion

headache

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Pathophysiology of concussion

acceleration/deceleration causing microscopic deformations. metabolism changes lead to an energy crisis

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What age group is at highest risk of concussion?

5-14 year olds

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Why are concussions less likely to be treated in older adults

social isolation because they dont want to admit theyre having problems or that they fell

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What is the leading cause of concussions in military personnel in active war zones

improvised explosive devices

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Who is more likely to have multiple concussions, military personnel or civilians

Military personnel in warzones

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T or F: the rate of concussions in sports is underreported

T, estimated to be 6-10x greater

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What risk factors are associated with a sports related concussion

Younger age

female gender

past history of concussion

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T or F: People with multiple concussions or history of pre-existing health concerns are more likely to have multiple concussion symptoms

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T or F: Men are more likely to have worse signs and symptoms of concussion

F, women are

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What physical attributes are associated with the gender difference in concussions

Strength, neck dimensions, hormones, brain connectivity

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What gender takes longer to recover from concussions

females

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12 Rs of sports related concussion

Recognize

Reduce

Remove

Re-eval

Rest

Refer

Rehab

Recover

Return to learn/sport

Reconsider

Retire

Refine

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implementing _______ prevention across all levels of sport is a priority that can reduce concussions

Primary prevention:

Rule changes

protective equipment

training

concussion management

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Should we still remove a player even if their concussion is not confirmed

Yes

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Which of the 3 Rs do first-responders handle

Recognize

Remove

Refer

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What is the slogan for working on the sidelines of sports

If in doubt, sit them out

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What assessment tool is made for medical professionals to use

SCAT6

Sport concussion assessment tool 6th edition

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What assessment tool is made for non-medical professionals to use

Concussion recognition tool 6

CRT6

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T or F: The CRT6 is used to diagnose concussions

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What age range is the SCOAT6 for

13+ Child SCOAT for 8-12

T or F: The SCAT6 is diagnostic for concussions

F, not diagnostic on its own does not replace a comprehensive medical assessment

When does the SCAT6 tool have the most utility

for acute concussion first 72 hours and up to 5-7 days after

What are the steps to the SCAT6 immediate assessment

Observable signs GCS Cervical Spine Assessment Coordination and ocular/motor screen Memory assessment

Steps to SCAT6 off the field assessment

Athlete background Symptom Evaluation Cognitive Screening Coordination/Balance assessment Memory Assessment Decision (to return or not)

Observable signs of concussion

Lying still more than 5 seconds No protective action w/ fall Motor incoordination- balance difficulties, stumbling Disoriented/limited responsiveness Blank look Facial injury Impact seizure High risk mechanism of injury

If patient has any of these red flags what do we need to do: Neck pain/tenderness Double vision Weakness/tingling/burning in more than 1 arm/leg Severe headache/increasing HA Seizure or convulsion LOC Deteriorating consciousness Vomiting Increased restlessness, agitation, aggressiveness GCS under 15 Visible deformity of the skull

Remove from play WITH spinal precautions Go to ED immediately

Treat all unconscious players as if ______ unless proven otherwise the ______ takes precedence

neck injury airway

SCAT6: cervical spine assessment questions

Neck pain at rest Tenderness to palpation IF no pain/tenderness, do they have full active pain free ROM Are limb strength and sensation normal

SCAT6: how to test coordination and oculomotor

is finger to nose normal for both hands with eyes open and closed without moving their neck or head, can the patient look side to side and up and down are extraocular eye movements normal

SCAT6 memory assessment

"First im going to ask you a few questions, please listen carefully and give it your best effort. First tell me what happened" What venue are we at today What quarter is it Who scored last........... can pick your own specific questions for the setting

Initial advice for concussion management

Avoid another concussion Avoid increasing physical or cognitive demand Monitored for first 24 hours no driving allowed not to be home alone be monitored during sleep that night no alcohol, drugs

Most concussions resolve ________________

10-14 days

How long should a person w/ a concussion have relative rest what is recommended after

24-48 hours light to moderate physical activity (walking/cycling) for first 5 days as long as symptoms are not exacerbated

What should a player do if their concussion symptoms suddenly worsen at home

Go to ED

T or F: early return to activities should be encouraged as long as symptoms don't increase more than 2 points on a 0-10 scale

Concussion return progression

Symptom limited activity -> Aerobic exercise -> individual sport specific exercise -> noncontact training -> full contact practice -> RTS

When should children return to sport post concussion

Not until 14 days after resolution of symptoms

After how many days is the typical re-eval for sports related concussion

3+ days

What are the recommendations for a player for the first 2 days post-concussion

reduce screen time, relative rest but full ADLs

How fast do we progress aerobic exercise in patients post-concussion if theyre symptom free during exercise

5bpm every 3 days exception: if they pass the test without symptoms but then get the symptoms later that night do not progress

Persistent post-concussion symptoms show after ....

10-14 days in adults and 4+ weeks in children

Risk factors for developing post concussion syndrome

Female gender Adolescent Hx of personal or family anxiety or depression DD or learning disorders pre-existing visual dysfunction Continuing to play post concussion severity of symptoms in first few days vestibular symptoms resting too long

If you see a patient for post concussion syndrome 14 days after their concussion what should you do

Refer to a concussion trained physical therapist

whiplash requires 4.5G or force, concussion require 60-160G, so what can we assume

That if someone has a concussion, then highly likely patients will also have a whiplash injury

In what order is PPCS typically treated

VIsual -> C Spine -> Vestib but we usually start with the system causing the most symptoms

If pt still has concussion symptoms but the c-spine, vestib system, and visual system are clear.. what is likely involved

ANS

What preventative measures are shown to decrease concussion

Neck strength. for every 1lb of strength odds of concussion dc by 5% Dynamic cervical stab Training of athletes self awareness of surroundings and collisions

What is CTE

Chronic traumatic encephalopathy way more common in pro athletes than general population

T or F: there are specific criteria that can lead someone to deciding to retire due to concussion

Does second impact syndrome have neuro imaging changes?

Yes

What is second impact syndrome

When someone sustains a second concussion before the first one has resolved… Can result in seizure and death

Steps of the full SCAT6

Immediate assessment: 1. Observable Signs 2. GCS 3. Cognitive Screen 4. Coordination and Oculomotor screen 5. Memory Assessment and Maddocks questions Off field assessment 1. Athlete background 2. Symptom Evaluation 3. Cognitive Screen 4. Coordination and balance 5. Delayed recall 6. Decision

Maddox score must be ________ or we remove from play

T or F: Athlete can have normal score on scat6 and still have a concussion

What are the 3 parts of the SCAT6 coordination measure

mBESS (modified balance error scoring system) Timed Tandem Gait Dual task gait

Where should the off-field SCAT6 assessment be done

In a distraction free environment with the athlete in the resting state

T or F: we should prescribe absolute rest to concussion patients for the first 48 hours

no, just relative rest

What are the 3 parts to the SCAT6 verbal cognitive test

Count backwards from7 or 3 Months backwards Immediate memory test

Persistent concussion symptoms are those that last over _________ in adults and over _________ in children

10-14 days 4 weeks

What is the difference between the SCAT and the SCOAT

The scoat is the "office assessment" done typically with followup

What outcome measure is used for re-eval of concussion in a dr office

SCOAT6 or Child SCOAT6 for 8-12

What age range is the child SCAT6 for?

5-12