History Any loss of consciousness? Note length of time unconscious for Determine level of consciousness (LOC) Alert- awake and responds immediately and appropriately Confused-impaired memory Lethargic- drowsy yet easily aroused Stuporous-asleep most of the time Semicomatose-no response to verbal stimuli Comatose-no response Headache Location, type
History Memory Anterograde amnesia- length of time from injury until conscious memory returns. Remember on field eval? 1 st thing after injury? Retrograde amnesia- loss of memory of events that occurred before the injury. Immediate recall- recall 3 to 4 words, ask to repeat words. Recent memory- repeat 3 words after 5 minutes
History Questions Do you know where you are? What happened to you? Can you remember the score, or who we played last week? (retrograde amnesia) Can you remember walking off the field? (antegrade amnesia) Does your head hurt? Do you have pain in your neck? Can you move your hands and feet? Can you remember if you have ever been knocked out before?
History Tinnitus Ringing in ears Dizziness Nausea Vomiting can be a life threatening sign Vision See the score board? Blurry vision?
Observation Obvious deformity Disoriented? Can they answer history questions? Blank or vacant stare? Difficulty keeping eyes open? Slurred or incoherent speech Delayed verbal and motor responses Gross disturbance in coordination Inability to focus, easily distracted Memory deficit, asking the same question over and over Length of time athletes affects abnormal Swelling or bleeding from the scalp Clear or straw colored fluid in ear canal Pupils Are they equal, round and reactive to light (PEARL) Discoloration
Palpation/Physical Exam Skull deformity Open wounds Palpate both the neck and skull
Special tests Neurological exam Cerebral testing Cognitive function Cranial nerve testing Rule out isolated injury Cerebellar testing Coordination and motor function Sensory testing dermatomes Reflex testing Balance Tests Romberg- stand with eyes closed, single leg and tandem stance, Balance error scoring system (BESS)
Special Tests Coordination Tests Finger to nose Heel-to-toe walking Heel to knee test Cognitive Tests Count backwards from 100 by 7 Spelling a word backwards Naming the months in reverse order 3 word recall Neuropsychological assessments