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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