Concussions Flashcards
(81 cards)
1
Q
Risk factors for concussions
A
- dehydration
- fatigue or sleep deprivation
- malnutrition
- concurrent illness
- illicit drug use
lower threshold
2
Q
Primary injury mechanism of concussions
A
- acceleration/deceleration injury to the brain
- unrestricted head movement leads to shear, tensile and compressive forces on the brain
3
Q
Is force alone predictive of concussion
A
only slightly
high forces from linear acceleration and rotational acceleration are associated with higher incidence of concussion
BUT low forces can produce concussions and high forces may not
4
Q
Location of the impact can help predict what in concussions
A
signs and symptoms
5
Q
S&S of frontal concussion
A
irritability, inappropriate tearfulness
6
Q
S&S of parietal concussion
A
HA. nausea
7
Q
S&S of occipital concussion
A
dizziness, disequilibrium, visual sxs
8
Q
Which type of impact is more likely to cause LOC
A
top of the head impact
9
Q
High risk mechanisms for concussions
A
- double hit hockey player
- trauma with rotational forces
- second hit
10
Q
Secondary injury mechanism of concussions
A
- injury happens immediately but clinical S&S take time to appear
- caused by neurochemical cascade
11
Q
Metabolic alterations that cause secondary concussion injury
A
- hyper acute ionic flux (K,Ca)
- indiscriminate release of excitatory NT
- acute hyperglycolysis
- sub acute metabolic depression
- inflammation
- decreased cerebral blood flow
12
Q
Halmark of secondary concussion injury
A
confusion and amnesia
13
Q
4 categories of concussion symptoms
A
physical, cognitive, emotional, sleep
14
Q
Physical symptoms of concussion
A
- LOC
- HA
- N/V
- balance/coordiantion problems
- dizziness, visual problems
- photo/phonophobia
- neck pain
15
Q
Cognitive symptoms of concussion
A
- confusion/disorientation
- blank or vacant stare
- difficulty concentrating
- speech problems
- difficulty with memory
16
Q
Emotional symptoms of concussion
A
- irritability
- sadness
- emotional lability
- nervousness
17
Q
Sleep symptoms of concussion
A
- drowsiness
- sleeping too much
- insomnia
18
Q
Who is the SCAT5 used by? Used for who?
A
designed for use by physicians and licensed healthcare professionals for people 13 and older
19
Q
Components of SCAT5
A
- immediate assessment
- athlete background
- symptoms evaluation
- cognitive screening
- concentration
- neurologic exam
- delayed recall
- decision
20
Q
What is looked for/ assessed in the immediate assessment in SCAT5
A
- red flags
- observable signs of concussion
- memory assessment (Maddocks questions)
- GCS
- cervical spine assessment
21
Q
What questions do you ask about the athlete during SCAT5
A
diagnosed concussions?
when? recovery time?
headaches or migraines? ADD or ADHA?
medications
22
Q
Cognitive screening during SCAT5
A
- orientation to date, time, month, year
- immediate memory (list of words and repeat)
23
Q
Concentration screening during SCAT5
A
- digits backwards
- months in reverse order
24
Q
Neurologic exam part of SCAT5
A
- read aloud and follow instructions
- full ROM of neck
- look side to side
- finger to nose
- tandem gate
- mBESS
25
Helmet sensors. Good? Bad?
not shown to be helpful in diagnosis of concussions
26
Linear acceleration >___ and rotational acceleration > ___ are associated with increased concussion risk
>100G
>5500 m/sec
27
Indications for ER evaluation of concussion
- prolonged LOC
- concern for C spine injury
- high risk mechanism for intracranial bleed
- exam suggesting skull fracture
- post trauma seizure
- deteriorating condition
28
Management of concussion in ER
- history
- neruo exam, restest q30mins
- pain meds for HA
- anti emetics for nausea
29
GCS is commonly used to measure what
severity of neurologic injury in concussion patients or mTBI
30
GCS immediately after injury? s/p injury?
ranges from 3-15 immediately after injury
should improve to 15 within 2 hours
31
When do you do a CT for a concussion pt
- LOC
- abnormal neuro findings
- deteriorating condition
32
What should be done 24 to 48 hours after concussion injury
"brain rest"
restrictions on cognitive and physical activity
avoid loud music, prolonged screen time, activities that require concentration
33
A pt with a concussion should have physical rest until when
no symptoms are present
mostly after 7 days
34
Management of HA associated with a concussion
NSAIDs or APAP
35
What medications should be avoided in patients with concussions
meds that alter cognition
| opiods, tramadol, muscle relaxants, benzos, alcohol, illicit drugs
36
How long should a concussion pt be observed for?
6-8 hours by a responsible adult to check and make sure there is no distress
37
What shouldn't you do to a sleeping concussion patient? Why?
wake them up
interferes with cognitive rest
38
Post concussion syndrome includes what things
- HA
- dizziness
- neuropsychiatric symptoms
- cognitive impairment
39
Correlation of severity of concussion with PCS
no correlation
40
Different theories behind PCS
- structural
- biochemical
- psychogenic
41
Management of PCS is geared towards what
major complints
42
Management of HA in PCS
- amitriptyline
- dihydroergotamine and metoclopramide infusions
- ocipital blocks
- propranolol
- indomethacin
43
What is second impact syndrome
death or devastating neurological injury attributed to massive brain swelling in athletes who sustain a second head injury before full recovery of the first
44
What does imPACT testing help with?
helps healthcare providers track recovery
helps educators make decision about academic needs after concussion
45
When are imPACT tests done
baseline every 2 years
after a suspected concussion to assess damage or changes
46
What does imPACT test measure
- player symptoms
- attention span
- working memory
- sustained and selective attention time
- response variability
- non verbal problem solving
- reaction time
47
Who should be notified that a student has a concussion
- teachers
- school counselor
- school nurse
- athletic trainer
- coach
48
Can students return to school after a concussion?
yes, but with academic alterations
- limited course load
- shortened class or school day
- increased rest time
- supplemental tutoring
- postponement of high stakes testing
49
Requirement of return to play protocol
- successful return to school
- symptom free and off meds
- normal neuro exam
- back to baseline balance and cognitive performance measures
50
Athletes must be what before progressing to the next level
symptom free during and after exertion at an activity level
51
How long should an athlete remain at a stage in RTP protocol?
no less than 24 hours
52
How many days should pass before an athlete returns to full competition
minimum of 5 days
53
What happens if a patient experiences symptoms during RTP protocol
- rest until resolved
| - attempt protocol again at previous level of symptom free exertion
54
RTP decision is a ___
medical decision!
55
What is chronic traumatic encephalopathy
perament changes in mood, behavior, cognition, somatic symptoms and in severe cases Parkinson type symptoms and dementia
56
Who does chronic traumatic encephalopathy occur in
pts with multiple concussions sustained over the course of an athletic career
57
Neuropathology of CTE
accumulation of abnomrla hyperphosphorylated tau in neurons and astroglia distributed around small blood vessels at the depths of cortical sulci
58
CTE is a what diagnosis
post mortem
59
What differentiates CTE from other tauopathies
distribution of tau protein
CTE--> superficial cortical layers
60
What is the "look up line"
warning track in hockey, warns players to keep their heads up when going into the boards
61
Take home messages about concussions
- they are evolving injuries
- no diagnostic tests
- clinical diagnosis
62
What are intracranial bleeds
TBIs
not concussions!
63
Where does a subdural hematoma occur
between the dura and arachnoid membranes
64
What causes a subdural
tearing of bridging veins that drain from the surface of the brain to the dural sinuses
65
What stops venous bleeding in a subdural
rising in intracranial pressure or direct pressure from a clot
66
Acute SDH. Subacute. Chronic.
Acute--> one to two days after trauma
Subacute--> 3 to 14 days after trauma
Chronic--> greater than 15 days
67
Imaging for SDH? How does it appear
head CT
crescent shaped
MRI is more sensitive for smaller bleed
68
Acute, symptomatic SDH is a what?
neurologic emergency
often required burr wholes or craniotomy
69
Most common cause of a subdural
Trauma--> MVC, falls, assault
70
Acute subdural presents with what
LOC or coma
71
Presentation of chronic subdural
insidious onset
HA, dizziness, cognitive impairment, seizures
72
Decision to operate on a pt with a SDH is based on what
- GCS
- head CT findings
- neurologic exam
- clinical stability
- acuity of SDH
- presence of comorbidities
- age
73
Where do epidural hemoatomas occur
in the space between the dura and the skull
74
Causes of an epidural hematoma
most often trauma
can occur spontaneously or d/t epidural abscess, infection or cancer
75
Where does the bleed come from in an EDH? Due to what?
meningeal arteries from a shearing and rotational forces and blows to the side of the head
76
What often coexists with an EDH
skull fracture
77
Clinical presentation of epidural hematoma
- pt typically lucid--> followed by rapid deterioration
- severe HA
- vomiting
- seizure
78
Diagnostics for EHD
head CT
LP in C/I'd
79
Treatment of EDH
neurologic emergency that requires craniotomy of burr whole evacuation
80
When do you do surgery in a patient with an EDH
- >30cm or mls reguardless of GCS
| - GCS <9 and pupillary abnormlaities
81
Once the burr wholes are made or craniotomy is done what do you need to do next
give unactivated prothrombin complex concentrates to reverse coagulation
