Management
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Management of head injuries is not an exact science. We must depend upon the honesty of the athlete in relating his true sensations, and balancing this with the on-field symptoms that are observed. The objective signs that need to be considered are: vital signs, level of consciousness, speech patterns, response to stimuli (both vocal and pain), pupil response to light, ability to ambulate, and neuro-sensory examinations. With these objective findings, one looks for degradation in the symptoms. Degradation of neuro-motor sign indicates a progressing head injury that needs immediate medical attention. Management of concussions is grade dependant, grade 0 concussions will miss less time than grade 3. Athletes with grade 0 or 1 concussions can be allowed to participate when the sensorium clears completely and the athlete is completely asymptomatic. It is prudent to observe the athlete for at least 10 to 20 minutes before allowing them to return to play. One should repeat the neuro-motor exam prior to return to play to ensure that all symptoms have cleared. Grade 2 concussions should not be allowed to return to play that day. When they are asymptomatic for 24 to 48 hours return to participation should be allowed with NO CONTACT. If during noncontact drills the symptoms do not return the next day contact is allowed. If a grade 2 concussion’s symptoms do not clear in 24 to 48 hours, the athlete needs to be seen by a neurologist for a complete examination. Release to play will be contingent upon the neurologist’s findings. Grade 3 concussions are removed from all activities, and transported to a medical facility if they show degradation in symptoms. These concussions need to have a neurological consultation to determine the extent of injury. They are not allowed to return to play until released by a neurologist. Grade 4 concussions need to be transported to a medical facility for physician consultation. These athletes should undergo a CT scan and have a neuro-surgical consultation. Return to play is, again, at the discretion of the neurologist. Grade 3 and 4 concussions will not be allowed to participate until they are asymptomatic for 2 to 4 weeks. At that point they may be allowed to gradually increase their activity level. Recurrent concussions involve difficult clinical decisions. The current thinking on return to play is based upon the number and severity of concussions that are sustained. If the athlete has sustained more that one grade 0 to 2 concussions, they should not be allowed to return to play until asymptomatic for one week. A third concussion of this level means disqualification for the remaining season. If the athlete receives two grade 3 concussions, activities should be ceased for one month with heavy consideration to missing the entire season. A third grade 3 concussion would mean disqualification for the season. Two grade 4 concussions is immediate disqualification for the season. |
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©2000 - 2006 David Edell Information on this site is not a substitute for physician directed care. Please consult your personal physician for more detailed information concerning specific injuries or illnesses. Last Update for AthleticAdvisor.com: 06/04/2006 12:01:52 PM |
