Whether or not a spine assessment is performed, a patient with a traumatic brain injury should be evaluated by a physician. Transport to the hospital by some means is indicated. Patients should be evaluated to rule out intracranial hemorrhage, monitored for increasing ICP, and counseled on when to return to sports and the signs of postconcussion syndrome.
Postconcussion syndrome is a constellation of symptoms that patients can experience starting about 24 hours following the initial injury. Symptoms include recurrent headache, difficulty sleeping, intermittent dizziness, ataxia, light sensitivity, attention and concentration problems and depression.8
Of the myriad different injuries high school athletes experience, a traumatic carotid artery dissection and mild traumatic brain injury can be easily missed during evaluation. Without proper treatment, both can cause long-term damage. By performing a careful patient evaluation of the head and neck, EMS providers can recognize the subtle symptoms of both injuries and influence their long-term management, potentially preserving the patient's neurological function and preventing permanent damage.
SIDEBAR: SPINE ASSESSMENT FOR BLUNT FORCE TRAUMA
- Free of distracting Injuries
- Free of intoxication (drugs or alcohol)
- Free of acute stress reactions (anxiety)
- Awake and calm, cooperative, sober and alert
- Free of spine pain
- Free of numbness and tingling in the body
Clear physical exam
- Free of spine tenderness
- Intact motor and sensory exam
- Distinguishes light touch from pain sensation in all extremities
- Equal bilateral finger abduction or finger/wrist extension against resistance
- Equal bilateral dorsiflexion and plantar flexion of the foot or great toe9
Carotid dissection is only one cause of bruit. There are many others, including plaque and fatty build-up. The presence of bruit following trauma should cause suspicion for carotid dissection, but not be treated as diagnostic.
A traumatic brain injury has occurred any time a patient experiences a blow to the head and any temporary alteration from their baseline neurological condition.
1. CDC. Sports-related injuries among high school athletes--United States, 2005-2006 school year. Morbidity & Mortality Weekly Report 55(38):1037-1040, 2006.
2. Zohrabian D. Carotid Artery Dissection. http://emedicine.medscape.com/article/757906-overview.
3. Iskander G. Personal communication on June 2, 2010. Dr. Iskander is director of trauma services for the Level II trauma centers at St. Joseph's Hospital and St. Joseph's Children's Hospital in Marshfield, WI.
4. Arnold MJ. Aspirin or Anticoagulation? Preventing Cerebral Ischemic Events after Carotid Artery Dissection. www.medscape.com/medline/abstracts19321846.
5. CDC. Nonfatal traumatic brain injuries from sports and recreation activities. Morbidity & Mortality Weekly Report 56(29):733-737, 2007.
6. CDC. How Many People Have TBI? www.cdc.gov/traumaticbraininjury/statistics.html.
7. Wilner A. Mild Traumatic Brain Injury/Concussions-New Department of Defense Guidelines. firstname.lastname@example.orgXehaK9wuIc@.29f95ecb!comment=1&cat=All.
8. Bernhardt DT. Concussion. http://emedicine.medscape.com/article/92095-overview.
9. Burton JH, Dunn MG, Harmon NR, et al. A statewide, prehospital emergency medical service selective patient spine immobilization protocol. J Trauma 61:161-167, 2006.
Kevin T. Collopy, BA, CCEMT-P, NREMT-P, WEMT, is an educator, e-learning content developer and author of numerous articles and textbook chapters. He is also a flight paramedic for Spirit Ministry Medical Transportation in central Wisconsin and a lead instructor for Wilderness Medical Associates. Contact him at email@example.com.
Greg Friese, MS, NREMT-P, is director of education for CentreLearn Solutions, LLC. He is an educator, instructional designer, author, presenter and podcaster. Connect with Greg on Facebook, Twitter, or e-mail him at firstname.lastname@example.org.