Episode 10: Concussion-Learning Points From Sport

Author: Eoghan Colgan    @eoghan_colgan
Special Guest: Jonathan Hanson

4/4/2018


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Guest Bios

Jonathan Hanson

Jonathan Hanson photo

Dr Jonathan Hanson is a consultant in Emergency Medicine and Sports Medicine and was part of the advisory group which recently released the latest Scottish Sports Concussion Guidance for grassroots sports participants.


Show Notes

Eoghan and Jonathan discuss concussion and how new guidelines should inform the management of all concussion patients in the ED.


Take Home Points

1.     Why it matters:

  •  Short-term: avoid second-impact syndrome which can occasionally be fatal
  •  Medium term: reduces the risk of musculoskeletal injury which is 30% more common in the weeks following concussion
  •  Longer-term: may reduce the likelihood of depression and dementia (though this is controversial)

2.     Pitch-side:

  •  If in doubt, sit the out (if you see anything suspicious)
  • Protect neck and do ABC assessment
  • At appropriate time check for symptoms/signs and do the Maddocks questions (rule in but not out)
  • If any concerning symptoms/signs then refer to A&E (as per SIGN guidelines)

3.     A&E:

  • Exclude neck and brain injury
  • If concussion is preset then you want to advise on a phased return to life/sport:
  • 3 stages
  • relative rest (24-48 hours)
  • return to normal life (24-24 hours between each stage)
    •  5-15 minutes of reading/screentime
    • increase tolerance with longer periods
    • back to school/work (half/day or working from home)
    • full return to normal activity
  • Return to sport (progessing through different phases which can be accessed through the link below)

4.     Non-resolvers after 2-3 weeks

  • Exclude a macroscopic brain injury
  • Should consider a SCAT-5 assessment tool
  •  Follow-up with neurology


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