A concussion occurs when a head injury causes a disruption of brain function. Some concussions are severe enough to cause unconsciousness, however, the loss of consciousness is not necessary for classification as a concussion. Many times athletes are just dazed. Even minor concussions, though, are serious injuries that must be evaluated and treated correctly.

Management of Concussion in Sports

FEATURES OF CONCUSSION FREQUENTLY OBSERVED

  1. Vacant Stare (confused/blank facial expression)
  2. Headache
  3. Delayed verbal & motor responses (slow to respond to questions or instructions)
  4. Confusion and inability to focus attention (easily distracted, unable to follow through with normal activities)
  5. Tinnitus (ringing in the ears)
  6. Disorientation (walking in wrong direction, playing wrong position; unable to recall time, date, place)
  7. Visual abnormalities (Photophobia-light sensitivity; blurred or double vision)
  8. Slurred or incoherent speech (disjointed or unintelligible statements)
  9. Dizziness
  10. Gross observable Incoordination (stumbling, inability to perform one leg standing test; Rhombergs Test)
  11. Emotions disproportionate to circumstances (distraught, crying for no apparent reason, paranoia, anger)
  12. Nausea
  13. Memory Deficits (athlete repeats same question that has already been answered, unable to recall events/circumstances of injury, inability to memorize and recall 3 of 3 words or 3 of 3 objects after 5 minutes)
  14. Any loss of consciousness (Brief-seconds, Prolonged-minutes)

    GRADES OF CONCUSSION

    Grade 1:

    1. Transient confusion (blank stare, inability to carry out goal-directed movement or maintain coherent stream of thought)
    2. No loss of consciousness
    3. Commonly referred to as having had their "BELL RUNG" or been "DINGED".
    4. Concussion symptoms or mental status abnormalities on examination resolve in less than 15 minutes.

    Grade 2:

    1. Transient confusion
    2. No loss of consciousness
    3. Concussion symptoms or mental status abnormalities (including amnesia) on mental examination last more than 15 minutes.

    Grade 3:

    1. Any loss of consciousness

    MANAGEMENT RECOMMENDATIONS
    Grade 1:
    1. Remove from contest
    2. Examine immediately and every 5 minutes for development of mental status abnormalities or post concussive symptoms at rest and with exertion.
    3. May return to contest if mental status abnormalities or post-concussive symptoms clear within 15 minutes.

    Grade 2:

    1. Remove from contest and disallow return to play that day.
    2. Examine on-site frequently for signs of evolving intracranial pathology.
    3. A trained person should re-examine the athlete the following day.
    4. a physician should perform a neurologic examination to clear the athlete for return to play after 1 full asymptomatic week at rest and with exertion.

    Grade 3:

    1. Transport the athlete from the field to the nearest emergency department by ambulance if still unconscious or if worrisome signs are detected (with cervical spine immobilization, if indicated).
    2. A thourough neurologic evaluation should be performed emergently, including appropriate neuroimaging procedures when indicated.
    3. Hospital admission is indicated if any signs of pathology are detected, or if the mental status of the athlete remains abnormal.

    WHEN TO RETURN TO PLAY

    An athlete may return to play only after all post-concussive symptoms have resolved both at rest and with exercise.

    *Grade 1 Concussion
    May return to play after 15 minutes if no headache or other post-concussive symptoms are present.

    *Multiple Grade 1 Concussions
    Return to play after 1 week without symptoms.

    *Grade 2 Concussion
    Return to play after 1 week without symptoms.

    *Multiple Grade 2 Concussions
    Return to play after 2 weeks without symptoms.

    *Grade 3 Concussion(brief)
    Return to play after 1 week without symptoms.

    *Grade 3 Concussion (prolonged)
    Return to play after 2 weeks without symptoms. May need to consider terminating season if symptoms persist.

    *Multiple Grade 3 Concussions
    Hold out at least one month. Base on decision of evaluating physician.

    ON-THE-FIELD PROTOCOL FOR AN UNCONSCIOUS ATHLETE

    Any time an athlete is knocked unconscious, a neck injury must be assumed and the athlete handled accordingly. Initial first aid must deal with life-threatening conditions such as impaired airways or hemorrhaging. Do not move the athlete, Check the following:

    (**PLEASE NOTE: Coaches and student trainers should leave these activities to qualified professionals, primarily physicians, EMT's, and Certified Athletic Trainers.)

    1.Check for airway obstructions. If breathing is obstructed, perform the following:

    2.The following may indicate concussion and/or skull fracture:




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    There are several warning signs that signal an immediate emergency, indicating that the athlete should be taken to the nearest emergency center:

    Any of these situations warrants immediate medical attention.

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    Recovery from a concussion will take a varying amount of time, depending upon the severity of the head trauma. Right after the injury, the athlete may not be able to recall the period of time just before or just after the trauma. The harder the hit, the longer the period of amnesia. The athlete may have trouble with short term memory, often asking the same questions repeatedly. Most individuals will eventually regain their memories, but some will always have sections of "lost" time surrounding the injury.

    For more information about the Management of Concussion in Sports Public Education Campaign, please call the Brain Injury Association at (703) 236-6000 ext.122.
    To order Palm Cards with Concussion Management Guidelines call (800) 321-7073

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