Athletic Injuries ATC 222

Head, Face, Eyes, Ears, Nose, and Throat

Chapter 22

Nervous System

• Central Nervous System– brain– spinal cord

• Peripheral Nervous System

Brain Anatomy• Cerebrum

• Cerebellum

• Brain Stem

Meninges• Dura Mater

• Arachnoid Mater

• Pia Mater

Head Injuries

• Incidence of serious injury has decreased– neck injuries?– protective gear

• Appr. 250,000 concussions/year

• Focal vs. Diffuse Injuries

Concussion

• Definition– clinical syndrome characterized

by immediate and transient impairment of normal neurological function

• Grades

• Return to Play Criteria

• Post-concussion Syndrome

• Second Impact Syndrome

Evaluation Process

• Primary Assessment?– ABC’s

• Secondary Assessment– Mental Status– Cranial Nerve Exam– Motor System Exam– Proprioception, balance, and

coordination

Cranial Nerve Exam• Test for:

– Vision– Tracking– Visual Fields– Pupil Reflex– Hearing– Swallowing– Shoulder Shrug– Facial Sensation– Facial Expression– Tongue Protrusion– Mastication

Other Signs and Symptoms

• headache

• nausea, vomiting

• seizures

• unequal pupils

• tinnitus

• unusual drowsiness

Treatment

• Should be mostly symptomatic in nature

• Recheck athlete on regular basis

• Refer if in doubt or in more severe cases

• Monitor throughout the night

• No alcohol, aspirin, ibuprofen

• No activity until asymptomatic

• Refer if current s/s worsen or if new s/s appear over time

Facial Injuries

• Mandible Fracture– deformity– malocclusion– malalignment– bleeding around teeth/gums– lower lip anesthesia– pain with biting

• Treatment

Facial Injuries

• Mandible Dislocation/Subluxation– commonly from lateral force– malalignment– malocclusion– open, locked jaw

Dental Injuries• Types

– fracture– dislocation/subluxation

• Treatment– realign subluxation– replace/preserve dislocation or

fracture– 30 minute survival rate

Nasal Injuries

• Fracture or Cartilage Separation– S/S

• deformity

• profuse bleeding

• immediate swelling

• crepitus

– treatment• control hemorrhaging

• referral

• most return to activity in 3-4 days

Nasal Injuries

• Epistaxis (nosebleed)– sit upright– ice (nose and ipsilateral carotid)– direct pressure on nostril– cotton/gauze plug– refrain from nose blowing for 2 hours

Ear Injuries• Hematoma Auris (cauliflower ear)

– causes– S/S

• swelling• redness, warmth• pain

– treatment• ice• protection• aspirate

Eye Injuries• Causes and Prevention

• S/S or Serious Eye Injury– prolonged blurred vision– loss of part/all of visual field (detached

retina?)– sharp, stabbing, throbbing pain– double vision– embedded object– blood in anterior chamber

Treatment of Serious Eye Injury

• immediate referral• cover both eyes with embedded

object• ice only to surrounding tissue• no pressure applied to eyes

Orbital Hematoma

• “Black Eye”• Bleeding in

orbit area and poss. Sclera

• Rule out serious eye injury

Foreign Body in Eye

• Embedded?

• Removal– Close eye– eye rinse– removal with gauze pad