Sitting on a freezing footy field in a mid June Toowoomba Saturday covering first aid for Rugby, may be your idea of Hell, but once the grizzling is done, I actually like it.
First Aid is where I started in the world of Emergency medicine all those 35 years ago.
I thought I'd dedicate this post to a common sports injury. The concussion.
Concussion is a closed traumatic brain injury that is graded from an insignificant mild Concussion where the person did not loose consciousness, through to the worst of persistent vegetative States (PVS) caused by a severe Diffuse Axonal Injury or DAI.
For the stock standard concussion that you see at sporting events on most weekends, the presentation of a "Classic Concussion" has sparked debate and controversy in locker rooms and clubs the world over.
A classic concussion is one where a traumatic blow to the head causes transient (5 seconds or more) of unconsciousness. Headaches, nausea, fitting and vomiting are common, as is ataxia (wobbly walk) and confusion of varying degrees.
A classic concussion used to be a normal inevitability of contact sport, and as such was often seen as a badge of honour. Perhaps more sinister was the false held belief that concussion was harmless, and never caused permanent brain injury. We now know that to be wrong. If someone sustains even one classic concussion, the neurosurgical community are now calling for an end to that victims contact sport career. Yes... One concussion. With overwhelming evidence to disprove a myth that CC was harmless, with newer sensitive scanning technology, we now know that permanent damage is done, and that the victim is now more susceptible to further and worsening extension if they receive another blow. Try selling that to coaches, and aggressive parents on the sidelines, and players hellbent on ignoring the science!!! Not easy.
With the improvement in mandatory rest periods, clever head protection, and rule manipulation, the risks of injury and permanent debilitation are minimised, but we need to be champions that teach the parents, players and coaches of the Weekend contact sports arena, what we now know is true.
They shouldn't play again. But selling this to the sporting community is like asking Americans to give up their guns.
At the very earliest is a recommendation to stay off the field for a minimum of 14-21 days.
In concussion, Axonal fibres (tails of brain cells) are stretched and or damaged in sudden head strikes, or torsional rotation mechanisms. These fibres, like all damaged tissues release inflammatory chemicals that start the process of secondary injury and cerebral hypoxia through a sudden rise in intracranial pressure. The shock wave of energy may render the player unconscious, or knock the "silly" into them. Any degree of an alteration in neurological function is seen.
The factor in level of, and duration of consciousness, is the extent of energy from the blow, and or the extent of neuronal damage.
Nerve cells regenerate with such a slow regrow that a large concussion may leave permanent deficit. We've all seen a "punch drunk" old boxer, or footy player.
The symptoms that follow, are almost certainly caused by the swelling local to this injury.
The big risk of playing again is referred to as ‘second impact syndrome’ and it is due to a repeated head trauma.
It occurs rapidly after single head impact in most published cases. Rapidly means, weeks or months, not hours or minutes.
It occurs rapidly after single head impact in most published cases. Rapidly means, weeks or months, not hours or minutes.
Pathophysiology may involve disordered autoregulation, that causes lack of blood flow to healthy areas of brain.
30% of concussion results in a post concussive syndrome when the patient may suffer from head ache, dizziness and confusion +/- personality, memory and concentration problems for up to 3-4 months post injury.
A cross-sectional study in retired football players showed a 2–3-fold increase in relative risk of clinical depression.
Concussion is not a harmless consequence of a contact sport. It is a poorly respected medical phenomenon that needs to have its awareness shared.
Do your part and share this post.
A paper last year that is a great go to for some RACGP refs, here http://www.racgp.org.au/afp/2014/march/sports-related-concussion/
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