Lesson #1

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HEAD INJURIES Anatomy of the Head * Skull is composed of 28 bones (10 main bones) * Suture line is the area where two bones in the skull come together. * Mandible (lower jaw) is the only moveable bone.

HEAD INJURIES 1. -

The Brain Made up of billions of cells (weighs 3 lbs) Requires 20% of total O2 Requires 15% of total blood supply. Cells grow and develop until age 18 Brain cells can be destroyed, but not reproduced. Lack of O2, pupils dilate in 60 sec 4-6 min, biological brain death occurs Pg. 47 figure 5.1

HEAD INJURIES 1. -

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The Brain cont.

4 lobes, parietal, occipital, frontal, temporal Brain attaches to spinal cord at brain stem via a crossover so right side of brain controls left side of the body. Cerebral Spinal Fluid bathes the brain in chemicals for proper functioning – maintains pressure – protects. Clear amber fluid NEVER STOP THE DRAINAGE – only increases the brain pressure

HEAD INJURIES 2. The Scalp -

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Part of the skin that covers the skull Contains blood vessels, muscles, and hair Skin protects from infection, hair protects from sun, dirt, and sweat Broken blood vessels in the head cause a hematoma (bleeding under the skin) Because of the scalp, it takes over 425 lbs of pressure to fracture the skull.

PREVENTING HEAD INJURIES 

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Prevented by helmets, mouth guards, rules, and common sense. Athletes should be taught the proper skills so injury can be prevented.

HEAD INJURY MECHANISMS   

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Caused by impact or rotation of the head. Most common is IMPACT. Region most susceptible is the Temporal region, bone is the thinnest. Contrecoup injuries occur when the head is moving and receives a blow – upon impact the brain sloshes to the side opposite the blow where it is stopped by the skull. Athletes will complain of a headache on the opposite side of the injury.

Lesson #2

TREATING HEAD INJURIES 

Life threatening head injuries include: skull fractures, concussions, and intracranial hematomas.

1. Skull Fractures: Occur when there is a significant force against the head. Several types can occur.

A. Depressed – pushes a portion of the skull inside towards the brain. Bleeding under the skin / laceration requiring bleeding control. B. Linear – occurs across the skull. No bones out of place but blood vessels tear inside the skull.

TREATING HEAD INJURIES C. Compound – results in a portion of the skull sticking through the scalp. Bleeding. D. Penetrating – involves an object that has gone through the scalp, skull, and very likely the brain. A skull fracture will discolor the area behind the ear (Battle Sign)

TREATING HEAD INJURIES 2.

Concussions – Temporary impairment of brain function caused by impact to the head or by rotating force. Symptoms include confusion, dizziness, loss of consciousness, nausea, vomiting, difficulty speaking, ringing in the ears (tinnitus) loss of balance, amnesia, possible battle sign, and disorientation. Graded like sprains and strains. ALWAYS monitor the athlete after the incident has occurred.

TREATING HEAD INJURIES 3.

Intracranial Hematoma – Severe bleeding within the brain caused by a blow to the head. (Temporal and parietal regions) Causes significant pressure on the brain, rapid death can occur. Athletes are often put in a coma to slow the brain activity down and give it time to heal. Symptoms include: headaches, nausea, vomiting, loss of consciousness, paralysis, and battle sign. Signs of a hematoma are rise in blood pressure and drop in pulse rate. Pupil on the same side of the injury will also be enlarged.

TREATING HEAD INJURIES Post Concussion syndrome is the persistence of symptoms, which may include the same as concussions. Usually does not last longer than a week or two. Second Impact Syndrome can occur when an athlete receives more than one concussion or blow in a relatively short time. The brain’s blood flow may be damaged.

Lesson 4

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FACIAL INJURIES Anatomy of the Face Injuries of the face can lead to permanent disfigurement or visual impairment. Immediate action by the ATC is necessary. Protective equipment is also essential. There are 18 bones in the face (some pairs) Major bones include the mandible, maxilla, zygomatic bones, sphenoid bone (contains the sinuses) located above and below the eyes.

FACIAL INJURIES  

Anatomy of the Face THE EYE 1. Sits in a socket (orbital Foreamen) which protects

the eye on 3 sides and serves as an attachment point for muscles that move the eye. Lack of eye mov’t can indicate a head injury. 2. Eye has anterior and posterior chambers filled with fluid which gives eye a round shape. Injuries to this result in damage, even blindness.

FACIAL INJURIES  

Anatomy of the Face THE EYE 3. Sclera – White outer covering of the eye. A change in color indicates a disease such as liver disease, lack of O2, even poisoning. 4. Cornea – Center clear portion of the covering. Protects eye from injury. Covers the iris and pupil. Made up of cells that can be damaged by wearing contact lenses too long. 5. Iris – Contractile colored portion of the eye. Cenetr portion is the pupil which is the opening in the eye.

Damage to any part of the optic nerve can cause blindness.

The all seeing EYE!!

FACIAL INJURIES 

Corneal Abrasion or Laceration  Mechanism 

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Poked in the eye with a foreign object or wearing contact lenses too long. Athlete will experience pain, sensitivity to light, vision problems.

Treatment 

Patch the eye, antibiotic ointment, always refer to a physician.

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Detached Retina  Mechanism 

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Blow to the eye, even a hard sneeze. Athlete will experience pain. Athlete will see sparks, lights, and flashes that nobody else can see.

Treatment 

Laser surgery, always refer to a physician.

FACIAL INJURIES 

Black Eye  Mechanism 

Blow to the eye. Caused by bleeding and discoloration just under the skin.

Treatment 

Apply ice for the swelling, always refer to a physician.

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Subconjunctival Hemorrhage  Mechanism 

Constant coughing may cause the small vessels in eye to rupture.

Treatment 

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Apply ice for the swelling, always refer to a physician. Looks painful, but is not.

FACIAL INJURIES 

Blowout Fracture  Mechanism 

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A blow to the eye causing the eyeball back into the socket. The thin bones beneath the eye fracture. Athlete will experience double vision, but little pain

Treatment 

Apply ice for the swelling, always refer to a physician.

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Ruptured Globe  Mechanism 

The eyeball can rupture due to force.

Treatment 

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Apply ice for the swelling, always refer to a physician. Protective devices are always used.

FACIAL INJURIES  

Anatomy of the Face The Ear - Has three distinct areas: external ear, middle ear,

and inner ear. 1. External – composed of the pinna (projecting portion of the ear which is cartilage covered by skin, purpose is to catch sound and funnel it in the auditory canal) the ear canal, and tympanic membrane. The auditory canal carries sound from the pinna to the tympanic membrane (eardrum) Too much wax interrupts the sound transfer.

The EAR!!

EAR INJURIES 

Cauliflower Ear (Hematoma Auris) 

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Mechanism – Pinna of the ear receives direct pressure causing the ear to bleed internally, redness and pain follow. As the ear heals, excessive growth accumulates making the ear look like a cauliflower. Treat with ice, may drain the ear, surgery.

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Otitis Externa (Swimmers ear) 

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Mechanism – Water stuck in the ear causing an inflammation of the canal. Pain, itching, and a smelly discharge will occur. Treat with antibiotic drops.

FACIAL INJURIES  

Anatomy of the Face The Nose - Two small bones, nasal bones, attach to the frontal bone of the skull. Bridge of the nose. Rest is cartilage. - Inside is the septum, cartilage that separates right and left. - The palate, roof of the mouth. - Air is warmed in the nose and cleaned before reaching the lungs. - In winter, breathing through the nose decreases lung pain.

FACIAL INJURIES  

Anatomy of the Face The Mouth - Mandible (Lower) maxillae (upper) ,

temporomandibular joint, tongue, palate, and teeth. - Mandible attaches to skull at TMJ and is only moveable part. - Adult has 32 permanent teeth. - Tooth anatomy (pg. 58) - Teeth, tongue, and saliva process food for nutrients and energy.

Mouth and Nose

PREVENTING FACIAL INJURIES 

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Epistaxis (Nose Bleed)  Lean forward pinching the nose.  Apply ice and pack with gauze.  Never lean the head back!! Nasal Fracture  Same as above.  May have crepitus, crunching sound during palpation.  Refer to a physician

Lesson 7

THROAT AND THORAX INJURIES Chpt. 7 

Anatomy of the Throat - Contains the carotid arteries, jugular veins, larynx, trachea, and esophagus. - Very vital passages for life. 1. Esophagus – passageway for food going from the mouth to the stomach. Lies in front of the cervical vertebrae and behind the trachea and larynx. 2. Trachea – made up of circular rings of cartilage. Main trunk of the system of tubes by which air passes to and from the lungs for exchange of CO2 and O2. 3. Larynx – Modified upper part of the trachea and contains the vocal cords. 4. Carotid Artery and Jugular Vein – pass on each side of the trachea. Carotid carry Oxygenated blood to the brain while Jugular carries unoxygenated blood away from the brain.

THROAT AND THORAX INJURIES Chpt. 7 

Anatomy of the Thorax - Made up of the thoracic vertebrae posteriorly, 12 ribs on each side, and sternum anteriorly. - Very vital passagaes for life. 1. Heart and Lungs – Heart is the size of a fist. Pumps blood to all parts of the body. Carries nutrients to the cells and waste out of the cells. Lungs are located on each side of the heart. Alveoli has the exchange of O2 in the lungs. page 72 - 73 2. Diaphragm – a muscle that separates the thorax and the abdominal cavity. Contracts and pulls down to assist in inhalation and moves upward to push air out of the lungs during exhalation. Has 3 openings – esophagus, abdominal aorta, and inferior vena cava.

Lesson 8

PREVENTING THROAT AND THORAX INJURIES 

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Protective equipment is designed to protect these areas since they contain vital organs. When buying equipment, make sure you buy the best available for protection. Some equipment is contraindicative!! (Baseball chest protectors)

TREATING THROAT AND THORAX INJURIES

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Can be simple or devastating. Most injuries to the throat are caused by direct blows from sticks, feet, or arms. Contusions are treated by applying ice. General response is coughing, spitting, difficulty breathing, and pain.

TREATING THROAT AND THORAX INJURIES 1. Throat lacerations: Two types, superficial lacerations are not deep and can be handled with direct pressure. Deep lacerations that affect the jugular vein or carotid artery are medical emergencies and require medical treatment. Apply direct pressure over the large vessels in the neck (tremendous blood loss) and call for help.

2. Cartilage Fractures: Caused by a severe blow to the throat. Can be life threatening. Athlete will have difficulty breathing, turn blue, and be very anxious due to lack of O2. Be very careful as the cervical spine may also be damaged. Place the athlete on a backboard and apply ice to reduce the swelling. Keep the athlete calm. Call for help.

SPECIFIC CONSIDERATIONS AND TREATMENT pg. 76-78 1. 2. 3. 4. 5.

6. 7. 8.

Rib Fractures Sternal Fractures Pneumothorax (Spontaneous & Tension) Flail Chest Pulmonary Contusions Hemothorax Sucking Chest Wound Hyperventilation

Top picture is a pneumothorax – air in the plural cavity.

Right – Broken ribs, resulting in a pneumothorax.

ABDOMINAL INJURIES 

Anatomy of the Abdomen: 

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The abdominal cavity is bounded by the lumbar spine posteriorly, the diaphragm superiorly, the abdominal musculature anteriorly, and the pelvis inferiorly. The abdominal cavity is divided into 4 quadrants, both horizontal and vertical. The upper-right quadrant lies just below the ribs on the right side and contains the liver, a portion of the pancreas, right kidney, gallbladder, and the small intestine. The upper-left quadrant lies just below the ribs on the left side and contains the stomach, portion of the liver, portion of the pancreas, left kidney, spleen, and large intestine.

ABDOMINAL INJURIES 

Anatomy of the Abdomen: 

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The lower-right quadrant contains the large and small intestine, appendix, a portion of the bladder, uterus and right ovary, and the prostate. The lower-left quadrant contains the large and small intestine, a portion of the bladder, uterus and left ovary, and the prostate. Both solid and hollow organs, injuries to hollow organs (bladder, intestines, stomach, and appendix) rarely cause rapid death. These organs can move and bend away if an athlete gets hit. Solid organs (liver, kidneys, spleen) can cause rapid death if hit.

ABDOMINAL INJURIES 

Anatomy of the Abdomen: 

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Abdominal organs can be divided into 3 categories: digestive, urinary, and reproductive. Digestive Organs 

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Stomach secretes gastric juices that assist in breaking down food before it enters the intestines. Liver has several functions, including the detoxification of chemicals, storage of several vitamins, produces bile, and assists with food metabolism. The gallbladder is located at the liver and is a storage house for bile. The pancreas produces insulin and enzymes for digestion. Small and large intestine complete digestion and produce waste. (Peristalsis in the stomach)

ABDOMINAL INJURIES 

Anatomy of the Abdomen: 

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Abdominal organs can be divided into 3 categories: digestive, urinary, and reproductive. Urinary Organs 

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Kidneys are responsible for maintaining the sensitive acid base within the body. If this changes, the body can die. Kidneys filter the blood and remove waste products of metabolism to keep the acid base stable. If blood supply is altered to either kidney, this can lead to hypertension and blood vessel constriction.

Reproductive Organs 

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Ovaries in females produce eggs for fertilization and estrogen. Seminal vesicles and prostate gland produce seminal fluid. Testicular contusion.

Pelvis and Abdominal Muscles.

ABDOMINAL INJURIES 

TREATING AND PREVENTING 

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Prevention is done with proper equipment and sport rules. An injury to a solid organ will be obvious due to abdominal pain, signs of shock, muscle spasms, or blood in the urine.

ABDOMINAL INJURIES 

Rupture of the Spleen 

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A blow to the abdomen may result in an injury to the spleen. An enlarged spleen is prone to injury, infection, and damage. Mono enlarges the spleen and athletes should not be permitted to play. Spleen injuries result in abdominal pain, and perhaps pain in the left shoulder (Kehr’s sign) 

Caused by internal bleeding which puts pressure on the diaphragm, which presses on a nerve causing referred pain to the shoulder. Nausea, cramps, vomiting, shock.

ABDOMINAL INJURIES 

Pancreas Injury 

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It is prone to injury during deceleration, when an athlete suddenly stops progress. Pancreas tears. The athlete will have pain in the middle of the abdomen to the back as well as nausea, vomiting, shock.

Kidney Injury 

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A direct blow to the kidney can cause a contusion, laceration, or rupture. Pain will occur under the posterior ribs to the side of the spine. Pain will increase with trunk extension and ease with hip flexion. Urine will have visible blood, athlete may pass out or feel nauseated.

ABDOMINAL INJURIES 

Hernias 

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A hernia is a lump of tissue, usually the intestine, that bulges through a weakness in the abdominal wall. Can result from increased abdominal pressure. Generally surgery is required. If not treated, the bulge can get stuck in the abdominal wall (strangulation) and cut off the blood supply to the tissue. A bowel obstruction results.

ABDOMINAL INJURIES 

Bladder Injuries 

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A rupture of the bladder will cause urine to leak into the surrounding area. Athlete may have painful urination, a contusion over the bladder, or blood in the urine. Send to a DOCTOR!!

Side Stitch 

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Refers to a pain in the upper abdominal region. Various theories: lack of O2 to abdominal muscles, improper breathing technique, muscle spasms. Athletes should stop the exercise and rest.

Work Activities:  

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Worksheet Chapter 8 Questions for review 1-3 Above and Beyond #1

SPINAL INJURIES 

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The joints in the spine consist of articulated bones supported by muscles and ligaments, also nerves. Because the spine protects our spinal cord, injuries to it can be life threatening. Anatomy of the Spine: Four segments (Sacrum, lumbar, thoracic, cervical). 

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Regular spine should have normal curvature and alignment, known as a neutral spine. (Comfortable) Bones in the spine are separated by disks and held together by ligaments. The muscles of the trunk permit many movements and also help stabilize. Bones are called vertebrae, 7-12-5-5 (Sacral are fused together)

SPINAL INJURIES 

Anatomy of the Spine: 

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The body spinal column has several functions including protection, holding the body upright for walking, and serving as a site for muscular contractions. Disks (intervertebral) lie between the vertebrae and absorb shock. They keep the vertebrae separated, which allows movement and a space for spinal nerves. Disk has two parts: Nucleus pulposus (jelly like core) annulus fibrosous (cartilage layers) 

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Disks do not get a blood suplly so they do not heal quickly.

Muscles attach to the spine and provide movement. Think of the spine as a mast on a ship, it has many cables attached to it that extend throughout the ship. The cables keep it stable.

SPINAL INJURIES 

Anatomy of the Spine: 

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If the ship has a mast that bends and fold, it will not work properly, same as the body. Certain muscles very important for stabilization and movement in the spine. (rectus abdominis, obliques, spinal extensors, upper trapezius, scalenius muscles) All involved with cervical rotation and flexion.

SPINAL INJURIES 

Postural Considerations 

Normal Posture: Always view the athlete from the side.

Picture a straight line dropping from the ceiling, the line will pass just behind the ear, through the center of the shoulder, through the greater trochanter of the hip, just behind the patella, and down to just in front of the lateral malleolus. 

Abnormal Posture: If the ear was projected in front of

the line (Forward head Posture) If the line passes through the back of the shoulders instead of the middle (Rounded shoulders) If the spine is rounded excessively (Kyphosis) Too much forward curve at the lumbar spine (Lordosis) Spine crooked rather than sunning straight down (Scoliosis)

SPINAL INJURIES 

TREATING LUMBAR SPINE INJURIES  Ligament Injuries – Commonly occur when an athlete is forced into excessive trunk flexion, or flex and rotate at the same time. (Football player being tackled and forced forward)  Generally have pain to one side and limited movement.  Always use PRICE to treat.

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Muscle and Tendon Injuries – Mild and moderate

strains are common.  Generally have pain to one side and limited movement, spasm. Pain is often present in the opposite direction you are bending.  Always use PRICE to treat.

SPINAL INJURIES 

TREATING LUMBAR SPINE INJURIES 

Bone Injuries – Bone fractures are possible in the lumbar spine. Forcefully landed on the gluteus can cause a compression fracture. 

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Spondylolysis – a stress fracture or bone degeneration of the vertebrae. Often found in gymnasts who arch their back and put a great deal of hyperextension. Spondylolisthesis – When the spondylolysis fails to heal causing the spine to become unstable allowing the vertebrae to shunt or slip forward. Disk Bulge – Occurs when the jellylike nucleus pulposus at the center of the disk pushes through the rings of the cartilage. This results in tremendous pressure and pain.

SPINAL INJURIES 

Other Common Injuries: 

Brachial Plexus Injury 

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This is a network of nerves that exit the cervical spine and run a course through the shoulder and arm. When the shoulder is pressed downward or stretched, it results in a burning, tingling, numbness, and stinging, called a BURNER or STINGER. Treatment is strengthening exercises and rest.