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Concussion



Prevalence


  • Most common neurological illness in young people.
  • Accounts for 5 - 15% of total injuries in most contact sports.


Symptoms and Signs


  • Wide variety.
  • Do not need loss of consciousness to be concussed.
  • Amnesia, dizziness, blurred vision, nausea, headache, attentional deficits, loss of consciousness.

Severity


  • Difficult to grade.
  • Should monitor symptoms – any change is more significant than any individual symptom.

Management

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Immediate...


DR ABC


D – danger R – response
A – airways B – breathing C – circulation and cervical spine

Later...

  • Full neurological examination.
  • Regularly monitored.
  • Home with a responsible adult, and a head injury card.
  • No drinking, driving, drugs.

Investigations...

  • Usually normal.

Return to Play


  • Contentious.
  • Traditionally 3 weeks off.
  • More sensible to regularly assess the player.
  • Decision should be symptom based...
    • Any symptoms – no play or training.
    • Symptom free – graduate return.
    • Any recurrence – further rest.

Post Concussion Issues

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  • Second impact syndrome – probably does not exist.
  • Post concussion syndrome.
  • Concussive convulsions.
  • Cumulative effects.

Prevention


  • Helmets – no evidence reduces risk of concussion in football codes.
  • Correctly fitted mouthguard.
  • Technical factors (tackling technique).
  • Neck muscle conditioning.
  • Proper coaching.
  • Rule changes (ban spear tackling / head high tackling).
  • Padding goalposts.

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