CONCUSSION MANAGEMENT:

Definition of concussion:

        - temporary change in mental state as a result of trauma (may be blow to head, face or jaw; may result from whiplash effect to neck) NOT NECESSARILY WITH LOSS OF CONSCIOUSNESS

Steps to follow:

        - c-spine precautions

        - airway, breathing, circulation

        - assess level of consciousness

Signs and Symptoms of Concussion:

        - headache      dizziness       feeling dazed   seeing stars    double or blurred vision        

        - sensitivity to light  ringing in ears  sleepiness      nausea/vomiting confusion

        - disorientation                feeling stunned poor balance    poor concentration      distracted

        - slow or slurred speech        slow responses to questions     vacant stare/glossy eyed

        - decreased playing ability     unusual/inappropriate emotions  personality changes

        - inappropriate behaviour (skate/run in wrong direction)        loss of consciousness

        - memory deficits/amnesia

Management of athlete with concussion:

        - when athlete shows any sings or symptoms of concussion:

        1) no return to current game or practice

        2) do not leave alone- regular monitory for deterioration essential; awaken every 2 hours overnight for first 24 hours

        3) medical evaluation necessary

        4) return-to-play must follow a medically supervised, stepwise process

Sideline evaluation:

        - Mental status testing: re-evaluate at regular intervals as long as symptoms persist

                * Orientation:

                        - time, place, person and circumstances of injury

                                - what day is it?

                                - what month is it?

                                - what gym/stadium/rink is this?

                                - whom are you playing?

                                - How did the injury occur?

                * Concentration:

                        - digits backwards (e.g. 2-8-0, 3-7-4-2, 5-1-6-9-3)

                        - months backwards (Dec, Nov, Oct, Sept…..)

                        - days of the week backwards ( Sun, Sat, Fri…..)

                * Memory:

                        - Names of teams in prior contest

                        - 3 object recall (0 and 5 minutes)

                                - e.g. white rabbit, red apple, blue car

                        - recent newsworthy events

                        - details of contest (score, who scored most recently, etc.)

                        - details of injury ( how injury occurred)

Physical Evaluation:

        - Neurologic Screening:

                - strength - (e.g. finger squeeze, strength arms & legs)

                - sensation - (e.g. numbness in extremities)

                - coordination - (e.g. tandem gait, finger-to-nose testing)

        - Exertional Maneuvres:

                - sprint

                - sit-ups

                - Push-ups

Return-to-Play:

        - Proceed to next step only when asymptomatic for 24 hours; if symptoms return, drop back to level where symptoms disappear for at least 24 hours and seek re-evaluation by physician)

        Step 1:  No activity, complete rest

        Step 2:  Light exercise (walking, stationary bike)

        Step 3:  Sport-specific activity (e.g. skating)

        Step 4:  "on field" practice without body contact

        Step 5:  "on field" practice with body contact (once cleared by medical doctor)

        Step 6:  Game play

"When in doubt, sit them out!!!"