Sports Concussion: Sideline and Initial Management Jim Fiechtl, MD Assistant Professor: Depts. Of EM and Orthopedics Vanderbilt Bone and Joint Clinic Vanderbilt

Vanderbilt Sports Concussion Center

Sports Concussion:Sideline and Initial Management

Jim Fiechtl, MDAssistant Professor: Depts. Of EM

and OrthopedicsVanderbilt Bone and Joint Clinic

Vanderbilt Bone & Joint


Disclosures• Unfortunately, I have no financial disclosures

to make, but I am always willing to listen.



Objectives• How to recognize?• What we are doing on the sideline?• Who goes to the ER



Who is concussed?

Vanderbilt Bone & Jointhttp://i.cdn.turner.com/si/multimedia/photo_gallery/0910/cfb.impact.injuries/images/tim-tebow.3.jpg


Who is concussed?


http://www.cbssports.com/mcc/blogs/entry/24156338/29747154


Who is concussed?


http://theother87.files.wordpress.com/2011/05/youth-soccer.jpg


Who does the evaluation?• Anyone trained– Means someone has

been trained– Coach– Certified Athletic Trainer– Physician– Team Parent


http://www.trophies2go.com/team-mom-trophy


What are we looking for?• Lying on the ground/slow to get up– Are they unconscious?

• Unsteady or wobbly• Grabbing their head• Dazed, blank look• Confused, running wrong plays


Pocket Concussion Recognition Tool™


Lying Motionless• If unconscious, assume

a cervical spine injury– C-spine control– Activate Emergency

Action Plan

• Take your time – ensure safety

• Needs to go to Emergency Department


http://mnhopper1s.files.wordpress.com/2011/10/spine.jpg?w=420&h=337


Able to Move

• Take your time – ensure safety• Move them to a ‘quiet’ area on the sideline• Give the player a few minutes to catch breath• Observe



Sideline Assessment• Maddocks’ Questions– What city and stadium?– Opponent?– Month and day?– Remember being injured, score of the game, the

play, etc• Memory and Cognition– Months, 3 objects, numbers backwards



Sideline Assessment• Brief Neuro Exam– Cranial nerves– Strength– Balance– Cerebellar



When can they go back in?

They’re done for the day.



Who needs a trip to the ER?• Worsening headache or

symptoms• Drowsy, hard to awaken• Repeated vomiting• Unusual behavior• Seizures• Weakness or numbness in arms

or legs• Slurred speech, unsteady walking

Vanderbilt Bone & Joint http://ia.media-imdb.com/images/M/MV5BMjA0NjI0ODgzNF5BMl5BanBnXkFtZTcwMDAxNDUyMQ@@._V1_SY317_CR20,0,214,317_.jpg

Putukian. BJSM 2013;47:285-8.

Documents

Sports Concussion: Sideline and Initial Management Jim Fiechtl, MD Assistant Professor: Depts. Of EM and Orthopedics Vanderbilt Bone and Joint Clinic Vanderbilt