SPORTS MED 2

Head Evaluation Process

History

Any loss of consciousness? Note length of time unconscious for

Determine level of consciousness (LOC) Alert- awake and responds immediately and

appropriately Confused-impaired memory Lethargic- drowsy yet easily aroused Stuporous-asleep most of the time Semicomatose-no response to verbal stimuli Comatose-no response

Headache Location, type

History

Memory Anterograde amnesia- length of time from injury until

conscious memory returns. Remember on field eval? 1st thing after injury?

Retrograde amnesia- loss of memory of events that occurred before the injury.

Immediate recall- recall 3 to 4 words, ask to repeat words.

Recent memory- repeat 3 words after 5 minutes

History

Questions Do you know where you are? What happened to you? Can you remember the score, or who we played last

week? (retrograde amnesia) Can you remember walking off the field? (antegrade

amnesia) Does your head hurt? Do you have pain in your neck? Can you move your hands and feet? Can you remember if you have ever been knocked out

before?

History

Tinnitus Ringing in ears

DizzinessNausea

Vomiting can be a life threatening signVision

See the score board? Blurry vision?

Observation

Obvious deformityDisoriented? Can they answer history questions?Blank or vacant stare? Difficulty keeping eyes open?Slurred or incoherent speechDelayed verbal and motor responsesGross disturbance in coordinationInability to focus, easily distractedMemory deficit, asking the same question over and overLength of time athletes affects abnormalSwelling or bleeding from the scalpClear or straw colored fluid in ear canal Pupils

Are they equal, round and reactive to light (PEARL)Discoloration

Palpation/Physical Exam

Skull deformity Open woundsPalpate both the neck and skull

Special tests

Neurological exam Cerebral testing

Cognitive function Cranial nerve testing

Rule out isolated injury Cerebellar testing

Coordination and motor function Sensory testing

dermatomes Reflex testing

Balance Tests Romberg- stand with eyes closed, single leg and

tandem stance, Balance error scoring system (BESS)

Special Tests

Coordination Tests Finger to nose Heel-to-toe walking Heel to knee test

Cognitive Tests Count backwards from 100 by 7 Spelling a word backwards Naming the months in reverse order 3 word recall Neuropsychological assessments