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