5--9--3--7--4 Months of year in reverse order Memory: names of teams in prior contest President, governor, mayor, recent newsworthy events, three words and three objects at 0 and 5 minutes. Details of contest (plays, moves, strategies, etc.) Exertional provocative tests: 40 yard sprint 5 push-ups 5 sit-ups 5 knee bends (any appearance of associated symptoms is abnormal, e.g., headache, dizziness, nausea, unsteadiness, photophobia, blurred or double vision, emotional lability, mental status changes) Neurologic tests: Pupils: symmetry and reaction Coordination: finger-nose-finger and tandem gait Sensation: finger-nose (eyes closed) and Romberg Grading scale and Guidelines for return to competition: Grade Features Actions Grade 1 no loss of remove from contest examine immediately and q5min for → consciousness, development of amnesia or postconcussive symptoms at rest and with exertion may return to contest if no amnesia & no confusion without → symptoms appear for at least 20 minutes. amnesia Grade 2 no loss of remove from contest and disallow return examine frequently → consciousness, for signs of evolving intracranial pathologic conditions → reexamine next day. confusion with amnesia Grade 3 loss of consciousness transport from field by ambulance (with cervical spine immobilization if indicated) to trauma hospital emergent → thorough neurological evaluation: signs of pathologic conditions hospitalization → normal findings instructions to family for overnight → observation. When to return to play after removal from contest: Grade of Concussion Time Return to Play* Multiple Grade 1 concussions 1 week Grade 2 concussion 1 week Multiple Grade 2 concussions 2 weeks Grade 3 - brief loss of consciousness (seconds) 1 week 3 - prolonged loss of consciousness (minutes) 2 weeks Multiple Grade 3 concussions 1 month (based on decision of physician) ≥ *only being asymptomatic with normal neurological assessment at rest and with exercise. - malignant (fatal) cerebral edema. at least 35 cases occurred among US football participants in 1980-1993. cause one minor HI followed in short order by second minor HI in athletes who are still – symptomatic from first injury. mechanism - impaired cerebral autoregulation vascular congestion brain edema herniation → → → sudden death. → prevention - postponed return to play for increasing lengths of time depending on concussion severity. see above Bibliography for ch. Trauma” follow this “Head →
5--9--3--7--4 Months of year in reverse order Memory: names of teams in prior contest President, governor, mayor, recent newsworthy events, three words and three objects at 0 and 5 minutes. Details of contest (plays, moves, strategies, etc.) Exertional provocative tests: 40 yard sprint 5 push-ups 5 sit-ups 5 knee bends (any appearance of associated symptoms is abnormal, e.g., headache, dizziness, nausea, unsteadiness, photophobia, blurred or double vision, emotional lability, mental status changes) Neurologic tests: Pupils: symmetry and reaction Coordination: finger-nose-finger and tandem gait Sensation: finger-nose (eyes closed) and Romberg Grading scale and Guidelines for return to competition: Grade Features Actions Grade 1 no loss of consciousness, confusion without amnesia remove from contest → examine immediately and q5min for development of amnesia or postconcussive symptoms at rest and with exertion → may return to contest if no amnesia & no symptoms appear for at least 20 minutes. Grade 2 no loss of consciousness, confusion with amnesia remove from contest and disallow return → examine frequently for signs of evolving intracranial pathologic conditions → reexamine next day. Grade 3 loss of consciousness transport from field by ambulance (with cervical spine immobilization if indicated) to trauma hospital → emergent thorough neurological evaluation: signs of pathologic conditions → hospitalization normal findings → instructions to family for overnight observation. When to return to play after removal from contest: Grade of Concussion Time Return to Play* Multiple Grade 1 concussions 1 week Grade 2 concussion 1 week Multiple Grade 2 concussions 2 weeks Grade 3 - brief loss of consciousness (seconds) 1 week 3 - prolonged loss of consciousness (minutes) 2 weeks Multiple Grade 3 concussions ≥ 1 month (based on decision of physician) *only being asymptomatic with normal neurological assessment at rest and with exercise. - malignant (fatal) cerebral edema. at least 35 cases occurred among US football participants in 1980-1993. cause – one minor HI followed in short order by second minor HI in athletes who are still symptomatic from first injury. mechanism - impaired cerebral autoregulation → vascular congestion → brain edema → herniation → sudden death. prevention - postponed return to play for increasing lengths of time depending on concussion severity. see above Bibliography for ch. “Head Trauma” → follow this