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Examination of Head Injuries

Examination Map DETERMINATION OF CONSCIOUSNESS

Level of Consciousness

Primary Survey

Secondary Survey

HISTORY

Head pain

Mechanism of Injury

Coup

Contrecoup

Rotational

Repeated subconcussive forces

 Loss of consciousness

 History of concussion

 Preexisting mood disorders

 Emotional impairment

 Weakness/fatigue

 Cognitive impairment

INSPECTION

Inspection of the Bony Structures

Mastoid process

Skull and scalp

Inspection of the Eyes

General

Nystagmus

Pupil size

Pupil reaction to light

Inspection of the Nose and Ears

Fluid escaping

Palpation

Skull

FUNCTIONAL ASSESSMENT

Cranial Nerve Assessment

Neurocognitive Function

Behavior

Analytical skills

Information processing

Memory

SCAT3

Balance and Coordination

Romberg test

Tandem walking test

Modified Balance Error Scoring System

Vital Signs

Respiration

Pulse

Blood pressure

Pulse pressure

REGION-SPECIFIC PATHOLOGIES AND SELECTIVE TISSUES TESTS

Traumatic Brain Injury

Concussion

Postconcussion Syndrome

Diffuse Cerebral Swelling

Intracranial Hemorrhage

 Epidural hematoma

 Subdural hematoma

Skull Fractures

 Halo Test

Determination of Consciousness

FIGURE 17-1

Establishing the presence of consciousness. (A) If the athlete is unconscious and prone, (B) roll to the supine position and determine an open airway, breathing, and circulation.

Inspection

FIGURE 17-2

Anisocoria, or unequal pupil size. Note the increased diameter of the patient's right pupil. This condition may result from pressure on the oculomotor nerve (cranial nerve III) or may be congenital.

FIGURE 17-3

Ecchymosis over the mastoid process, Battle's sign, may suggest a skull fracture.

Functional Assessment

Table 17-1Cranial Nerve Function

Neurocognitive Function

FIGURE 17-4

Types of amnesia. Retrograde amnesia is the loss of memory from the onset of ...

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