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90 Cards in this Set

  • Front
  • Back
Explain the pathophysiology of a concussion.
- Complex pathophysiological process affecting the brain induced by traumatic biochemical forces.
- Caused by an impulsive force transmitted to the head.
- Results in rapid onset of short-lived impairment of neurological function that resolves spontaenously.
- Graded sets of clinical syndromes.
Does the acute clinical symptoms of a concussion reflect a functional disturbance or structural injury.
Functional disturbance.
What are the complications of a concussion?
- Impaired reaction time.
- Delayed information processing.
- Second impact syndrome.
- Post-concussive syndrome.
What is the treatment for a concussion?
- Exclude serious injury.
- Admit to hospital if:
a) Focal neurological signs.
b) Cerebral irritation > 1 hour.
c) Deteriorating mental state.

Relative indications:
d) Loss of consciousness greater than 5 minutes.
e) Convulsion.
f) > 1 episode of moderate to severe concussion in season.
What are the cognitive features of a concussion?
- Unaware of the score, period of a game, etc.
- Confusion.
- Amnesia.
- Loss of consciousness.
- Unaware of time, date, place, etc.
What are the signs and symptoms of a concussion?
- Headache.
- Dizziness.
- Nausea.
- Unsteadiness and poor coordination.
- Poor concentration.
- Unusual emotions and personality changes.
- Reduced playing ability.
- Visual disturbance.
Return to activity protocol for a possible concussion.
- 6 step return-to-play protocol.
- Full STM & information processing.
- Neuropsychological testing - DSST.
What are the indications for ordering a CT or MRI in a concussion?
- Prolonged disturbance of conscious state.
- Focal neurological deficit.
- Seizure activity.
- Persistent clinical symptoms.
Preventative measures against concussion.
- Mouth guards.
- Conditioning neck muscles.
- ?Headgear.
- Rule changes.
What percentage of spinal injuries is caused by an motor vehicle accident?
What percentage of spinal injuries in caused by sport?
What are the typical causes of spinal injury?
- Forced flexion.
- Axial compression.
- Hyperextension.
- Flexion/rotation.
When do you start suspecting a spinal injury?
- Nature of injury e.g. direct blow or severe deceleration.
- Pain & tenderness.
- Neurological symptoms - even if transient.
- Comatose or stuporose.
- Associated injuries:
Facial e.g. nose or jaw fracture.
Head injury especially if LOC.
Assessment of possible spinal injury include:
- ABC.
Initial assessment
- LOC.
- Motor loss.
- Sensory loss.
- Spinal palpation.

More detailed assessment:
- ABC.
- BP.
- Full neuro assessment, including:
= Document highest normal motor level and specific movements.
= Document sensory level - light touch and pinprick.
= Sacral sparing - lesion incomplete.
When transferred to hospital, spinal injuries should have what in the way immediate management?
- Nasogastric tube if significant defect.
- IV -- Nil by mouth. Beware of neurogenic shock. Don't overload. 80mms systolic is satisfactory.
- IDC.
- Oxygen.
- Analgesia.
- Antiemetics.
- Imaging.
What imaging investigations should be ordered for a spinal injury?
- Xray in collar - lateral initially including C7.
- If normal, AP & oblique.
- CT scan if any evidence of fracture.
Extensive subconjuctival haemorrhage may indicate what?
Retrobulbar haemorrhage and/or basal fracture.
What possible eye injuries may involve the cornea?
- Abrasion or erosion.
- Foreign body.
What possible eye injury may involve the iris?
What possible eye injuries may involve the lens?
- Trauma.
- Subluxation risk in Marfan's syndrome.
What possible vitreous injury of the eye may occur?
- Haemorrhage.
What kind of retinal injuries may occur?
- Haemorrhage.
- Tears.
- Detachment.
To avoid penetrating eye injuries, do the following:
- Never force open lids.
- Never use local anesthetic to decrease pain.
- Never instill ointments.
- Never double-fold pad.
- Urgent referral.
What kind of retinal injuries may occur?
- Haemorrhage.
- Tears.
- Detachment.
To avoid penetrating eye injuries, do the following:
- Never force open lids.
- Never use local anesthetic to decrease pain.
- Never instill ointments.
- Never double-fold pad.
- Urgent referral.
Direct impact to the eye can result in fracture of...
the bony orbit.
Fracture of the bony orbit results in double vision upon upward gaze. This is due to...
entrapment of the inferior rectus muscle.
With a fracture of the bony orbit, you should avoid blowing your nose. Otherwise...
it may allow contents of the maxillary sinus to track into orbit.
If you suspect eye injury, you need to examine the following:
- Visual acuity.
- Visual fields.
- Pupil and iris.
- Evert lids.
- Ocular movements.
Equipment used in treatment of eye injuries.
- V.A. card.
- Penlight.
- Flurosceine strips.
- Eye pads.
- Cottonbuds.
- Irrigating solutions.
If a chipped or avulsed tooth cannot be found after a tooth injury, what may need to be ordered?
Chest & abdominal x-ray.
What happens if you get a crown fracture that exposes the dentine?
It becomes painful and requires urgent dental referral.
Before you refer to a dentist, what needs to be done for a tooth subluxation injury?
Repositioning and splint.
How do you treat a tooth avulsion?
- Irrigate the retrieved tooth with sterile saline solution or milk.
- Reimplantation and splint if patient is conscious.
Clinical features of a zygoma fracture:
- Bruising eyelid.
- Asymmetry.
- Paraesthesia or numbness of the cheek.
- ? teeth feel normal.
Clinical features of a zygoma fracture:
- Bruising eyelid.
- Asymmetry.
- Paraesthesia or numbness of the cheek.
- ? teeth feel normal.
Orbital floor fractures can result in sensory loss to the face due to...
infra-orbital nerve damage.
For a possible mandibular fracture, what things do you need to examine for?
- Check teeth for blood or displacement.
- Examine for sensory loss to lip, chin & lower teeth.
- Check dental occlusion.
- Feel for fracture.
Sensory loss to lip, chin and lower teeth from a mandibular fracture is due to...
inferior alveolar nerve damage.
Ear injuries
How is a haematoma of the ear treated?
Usually requires drainage and packing for 2 weeks to prevent cauliflower ear.
Laceration of the ear...
1. Frequently involves what type of tissue?
2. Requires what for treatment?
1. Cartilage.
2. Oral antibiotics.
Ear injuries
Avulsion requires what treatment?
- A lot will survive on the small pedicle.
- Evert edges, drain haematoma, pack & pad for 2 weeks.
Common nose injuries in sport.
- Epistaxis.
- Nasal fractures.
- Septal haematoma.
Nose injuries

What are the clinical features of a septal haematoma?
- Increasing pain with possible fever.
- Cherry like structure occluding nasal passage.
Nose injuries

How do you treat a septal haematoma?
- Evacuation of the clot with a wide bore needle or small incision followed by packing.
- Antibiotic prophylaxis to prevent septal abscess & subsequent cartilage necrosis.
Main causes of chest injuries in sports
- Acceleration/deceleration.
- Compression.
- High speed impact.
Multiple rib fractures, especially in the elderly or those with chronic lung disease, can cause serious...
Difficulties in ventilation.
Fracture of the first rib may be associated with...
Aortic rupture.
Fractures of the lower ribs may be associated with...
Rupture of the spleen or liver.
What is a flail chest?
Isolated segment of ribs displaced outwardly during expiration.
What is the treatment for flail chest?
- Selective endotracheal intubation in patients exhibiting significant difficulties in oxygenation.
- Use of epidural narcotics or local anaesthetics is the best form of analgesia.
Scapular fractures are significantly associated with what complications?
Pulmonary contusion, brachial plexus injury and arterial injury. This is why hospital admission is advisable.
Why do most sternal fractures require no therapy?
Because most sternal fractures are non-displaced.
What do sternal fractures increase the incidence of?
It slightly increases the incidence of myocardial contusion and aortic rupture.
Costochondral injuries can cause very severe pain. What management steps are involved in treating a costochondral injury?
Initial management is conservative with rest & local heat application.
If pain persists, local anaesthetic injections or intercostal nerve block can be used.
Whereabout's on the clavicle do 80% of clavicular injuries occur?
Middle third of the clavicle. Most clavicular injuries heal without difficulty.
Anterior & posterior sterno-clavicular dislocations can usually be reduced with...
Closed technique and local anaesthesia.
Tension pneumothorax is potentially fatal. How is it diagnosed?
Recognised by diminished breath sounds with possible shift of the trachea to the contralateral side.
Tension pneumothorax is potentially fata. How is it treated initially?
Insertion of a 14-gauge catheter into the 2nd intercostal space in the mid-clavicular line is usually adequate initial treatment.
How should an open pneumothorax be handled?
It should be covered and secured on 3 sides.
What structures are usually injured to cause a haemothorax?
Great vessels, bronchial circulation, lung parenchyma, or intercostal vessels.
How should fluid collections from a haemothorax be drained?
With a large bore chest tube in the 5th intercostal space.
An urgent thoracotomy is usually necessary for a haemothorax if...
Initial drainage > 1500ml or continues at a rate of > 300ml/hr for 3 consecutive hours.
Which organ is most vulnerable to abdominal injuries in football?
Which organ is most frequently damaged in boxers?
Abdominal injuries to the pancreas are _____ but have a _____ mortality.
Abdominal injuries to the pancreas are rare but have a high mortality.
Hollow viscera injuries are uncommon abdominal injuries. However, fixed areas such as _____, ______, and _____ are most vulnerable.
Hollow viscera injuries are uncommon abdominal injuries. However, fixed areas such as duodenum, 1st part of the jejunum and caecum are most vulnerable.
In what situation is the spleen particularly vulnerable to abdominal injury?
When enlarged, such as in lymphoma or infectious mononucleosis. Contact sports are contraindicated for 6 months after all symptoms have disappeared.
Rupture of the spleen may be delayed and can be fatal if missed. What do you need to do if there is any suspicion of splenic injury?
Order a CT scan.
What management is useful for kidney damage from abdominal injuries?
Most cases can be managed by conservative treatment including bed rest, IV fluids, antibiotics and careful observation.
If kidney damage results in frank swelling, evidence of hypotension and increasing pain, what should be done?
About 50% of liver injuries are simply...
Bleeding is usually minimal and self-limiting in these causes.
Capsular tears or superficial parenchymal lacerations.
CT scan of the liver in sports injuries might...
Determine the extent of the liver injury. This is often important to do as severe injury with massive bleeding requires immediate surgery.
What should you be suspicious of with liver injuries?
Bowel peritonitis.
2nd and 3rd parts of the duodenum are vulnerable to contusions caused by...
Impaction against the vertebral column. A resulting haematoma may go unrecognised until vomiting appears.
What is required if there is suspicion of duodenal, pancreas or colon injury?
CT scan.
Injury to colon in blunt force trauma may go unrecognised until what complication?
Peritonitis (so CT scan to be safe!).
Pelvic fractures usually occur in what type of sport?
High speed sports
If the pelvic ring has been destroyed in a pelvic fracture, what complications may occur?
- Ruptured bladder.
- Ruptured urethra.
- Rectal injury.
- Internal haemorrhage.
List the possible causes of acute knee pain. Include a list of NOT TO BE MISSED causes.
- Medial meniscus tear.
- MCL sprain.
- ACL rupture.
- Lateral meniscus tear.
- Articular cartilage injury.
- PCL sprain.
- Patellar dislocation.

- Fractured tibial plateau.
- Avulsion fracture.
- Osteochondritis dissecans.
- Reflex sympathetic dystrophy.
Steps in the examination of the knee.
1. Observation.
- Standing, walking and supine.
- Look for swelling, deformity and bruising.
2. Active movements.
3. Passive movements.
4. Palpation.
5. Special tests
- Presence of effusion.
- Stability tests: MCL, LCL, ACL (Lachman's, Anterior Draw, Pivot Shift), PCL.
- Stability tests (McMurray's, Patellar Apprehension Test).
Possible investigations for knee injuries.
- Xray.
- MRI.
- Ultrasound.
- Arthroscopy.
- CT scan.
List the possible causes of shoulder pain (including a NOT TO BE MISSED list!)
- Rotator cuff strain & tendinopathy.
- Glenohumeral dislocation.
- Glenohumeral instability.
- Referred pain.
- Fractures.
- Muscle tears.
- Brachial plexus injuries.
- Adhesive capsulitis.
- Nerve entrapments.

- Tumours.
- Referred pain from diaphragm, gallbladder, perforated duodenal ulcer, cardiac & spleen.
- Thoracic outlet syndrome.
- Axillary vein thrombosis.
What structures do you need to examine for in a pelvis and groin injury?
- Osteitis pubis.
- Stress fracture pelvis.
- Stress fracture femur.

- Hip.
- Sacroiliac joint.
- Lumbar facet.

- Adductors.
- Hip flexors.
- "Hernia"
Active Movements needed to be assessed with a pelvic/groin injury.
- Hip flexion/extension.
- Hip abduction/adduction.
- Hip internal/external rotation.
- Squeeze test.
- Lumbar spine movements.
- Abdominal flexion.
- Iliopsoas flexion.
Passive Movements needed to be assessed with a pelvic/groin injury.
- Hip quadrant.
- Adductor muscle stretch.
- Quadriceps muscle stretch.
- Psoas muscle stretch.
Resisted Movements needed to be assessed with a pelvic/groin injury.
- Hip flexion.
- Hip adduction.
- Abdominal flexion.
- Iliopsoas flexion with adduction.
Structures needed to be palpated with a pelvic/groin injury.
- Adductor muscles/tendon.
- Pubis symphysis/ramus.
- Rectus abdominis.
- Iliopsoas.
Functional movements needed to be assessed with a pelvic/groin injury.
- Hopping.
- Sit-up.
- Lunge.
- Zig-zag.
Special tests in the examination of pelvic/groin injuries.
- Lumbar spine.
- Sacroiliac joint.
- Patrick's (FABER) test.
- Thomas test.
- Trendelenburg test.
- Cough impulse.
- Ober's test.