| A | B |
|---|
| skull fracture | Signs and symptoms: Severe headache • Nausea • Possible defect or dent in skull • Raccoon eyes o Discoloration around eyes caused by skull fracture • Battles sign o Discoloration behind the ears caused by head injury • Possible cerebrospinal fluid leaking from ears or nose (yellowish-clear sticky fluid) Treatment • Referral to physician immediately to rule out any possible complications • RTP dependent on severity of skull and brain trauma |
| Mandible (Jaw) Fracture | Signs and symptoms: Pain in injured area, especially with movement or compression • Possible deformity • Bleeding around teeth or loss of teeth • Headache Special tests • Have athlete bite down on a tongue depressor, move jaw laterally, or open and close his mouth • + sign, increased pain, decreased range of motion, inability to complete the task treatment • referred to physician for repair of jaw, may include surgery or wiring/banding jaw shut. • Liquid diet may be required to limit movement • Light activity allowed with progression of exercise as symptoms resolve • Rtp may be allowed in 8-12 wks with proper precautions (custom mouth guards and protective masks. o Rtp May be earlier if fracture is nondisplaced and risk of reinjury is minimal |
| Orbital and zygomatic fractures | • Bones that comprise floor of eye socket and upper cheek area • Blowout fracture o Fracture of the orbital floor occurring as a result of a sudden increase in pressure from a direct blow to the eye Signs and symptoms • Pain I inured area • Double or blurred vision • Difficulty moving eye(orbital fractures can cause inability to look up) • Photophobia o Sensitivity to light • Bleeding or nose • Possible deformity in cheek Treatment • Refer for x-rays • Ice for swelling and rest • Surgery may be required for deformity or dysfunction • RTP 6-8 wks if symptoms resolve. • Activity not allowed until cleared to compete to avoid further damage to the bone and surrounding tissue |
| Detached retina | • Typically painless , but an do permanent damage to vision Signs and symptoms • Vision difficulties including floating specks, blurred vision, and flashes of light • Athlete complains of a curtain falling or coming down at the edge of the eye, reducing peripheral (all that is visible to the eye outside the central area of focus) dramatically Treatment • Referred to an ophthalmologist to determine whether surgery is required to repair/attach retina • If surgery not necessary bed rest with bilateral eye covers can allowed time to recover minimizing further damage • RTP depends on severity and if surgery is required |
| Corneal abrasions | • Cornea is transparent portion of sclera: o A dense, white, fibrous membrane that, with the cornea, forms the external covering of the eyeball. Signs/symptoms • Severe pain in eye • Sensation of having something in eye • Watering or tearing of eye • Photophobia Treatment • Refer to physician to rule out abrasion o Use fluoresceine strips and blue light to determine this • Eye path and antibiotic ointment drops will heel the injury • Avoid sunlight until symptoms decrease or resolve • RTP when has no vision difficulties and symptoms have resolved o Usually days |
| Hyphema | • Collection of blood in sclera of eye Signs and symptoms • Reddish, bloody tinge in sclera • The color may change to brown or green after 24-48 hrs • Vision difficulties Treatment • Refer to physician • Bilateral eye patches, sedation, medication, and/or bed rest may be recommended • Bleeding should reabsorb over course of several days • Not treated properly could lead to permanent vision damage |
| Nasal fracture | • Most common facial fracture Signs/symptoms • Pain at affected site • Profuse bleeding • Immediate swelling and discoloration • Raccoon eyes • Possible deformity in nose or bump on bridge of nose • Crepitus • Difficulty breathing Treatment • Refer for x-rays and possible reduction of a displaced fracture: o A fracture in which the broken fragments of the bone are separated from each other and not aligned • If simple fracture can rtp in few days with proper splinting and face shield • Complicated fractures may require surgery to improve athlete’s ability to breathe properly |
| Nosebleeds (Episaxis) | Signs and symptoms • Mild to profuse bleeding • Possible pain or swelling Treatment • Determine cause to rule out fracture • Apply pressure to bridge of nose and bend head forward o To keep blood from traveling down throat to stomach • Provide gauze or nose plug to collect the blood • Apply ice to back of neck to decrease blood flow • If bleeding doe not stop gauze can be place within upper lip to provide pressure to base of nose • Rtp as soon as bleeding controlled as long as no fracture |
| Cauliflower ear | • Hematoma that develops I cartilage of ear Signs and symptoms • Swelling within cartilage of ear • Possible bleeding • Scarring from a previous injury may be present Treatment • Prevent with use of petroleum jelly, skin lube, or protective headgear over ears during activity • Once formed need to have fluid drained and compressive pack placed on ear either sutured or taped in place for at least one weak • Left untreated will calcify and a lumpy shape similar to a cauliflower will remain on ear permanently only can be removed with cosmetic surgery • Rtp is possible as soon as pain is resolved |
| grade 1 concussion signs and symptoms | o Dizziness/headache o Ringing in ears (tinnitus) o Blurred or double vision o Nausea o Sensitivity to light/noise o Possible slight amnesia (retrograde or anterograde) • Retrograde: loss of memory and inability to recall events before the traumatic event • Anterograde: loss of an athlete’s immediate memory and ability to recall events that have occurred since the injury o Disorientation o Inappropriate emotional reaction o Any change in normal personality o Confusion or lack of concentration o Possible cranial nerve dysfunction o no loss of consciousness o symptoms last less than 30 minutes |
| grad 2 concussion signs and symptoms | o same as grade I but more sever and last longer o amnesia may last up to 24hrs o there is no loss of consciousness or lasts less than 1 minute o symptoms last 30min-24hrs |
| grade III concussion signs and symptoms | o preceding symptoms may be more sever and will last longer o loss of consciousness at onset of injury last more tan 1 min o symptoms may last more than 7 days |
| special tests for concussions | administer a baseline test to measure the athlete’s cognitive ability prior to injury • assessment test should be readministered at various intervals post-injury • scores can be compared to pre-injury results to determine whether a cognitive deficits are present as result of injury |
| treatment grade 1 concussion | o monitor to see whether symptoms resolve o may return to competition after 20 minutes after passing an on-field assessment and symptoms are resolved o athlete should be removed form competition for rest of match if symptoms recur or increase with exertion. Day after game should be tested again and compare to baseline. o If symptoms recurred worsened or cognition test demonstrates mental deficits must see physician |
| treatment grade 2 concussion | o Removed from rest of competition and monitored o See physician following day for through eval o Tested periodically with cognition test o Must be asymptomatic for at least one week both at rest and during an exertion test prior to any return to play • If pass may begin restricted activities and increase participation as long as symptoms don’t recur |
| treatment grade 3 concussion | o Treated as potential spinal cord injury with athlete being spine-boarded and removed fro field o Transported to hospital for immediate eval o Tested periodically for cognition and removed from lay until returns to baseline levels o Must by asymptomatic from 1 wks to 1 month depending on symptoms, previous history of concussion, and grading system utilized o Can return to restricted activity after exertion test • Continue for several days and then progress to full activity if remain asymptomatic o Consistent follow up and communication with physician maintained throughout recovery |
| general rules in treating concussion | • 1st 24 hrs monitor closely to ensure no serious side effects o should not be given aspirin or anti-inflammatory meds, bc of blood-thinning effects and potential for intracranial bleeding o allowed to sleep post injury but should be monitored to ensure don’t get worse • if any point become nauseated or symptoms increase go to doctor • if has 2nd concussion during the recovery time doubled for whichever grade concussion individual suffers |
| second-impact syndrome | • results in rapid swelling an herniation of already-injured brain, causing excessive bleeding and pressure • athletes under 20 most susceptible • will deteriorate rapidly, leading to unconsciousness and respiratory failure • life threatening (50% mortality) |
