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
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
Links
https://sportfirst.sportscotland.org.uk/articles/if-in-doubt-sit-them-out/
https://sportscotland.org.uk/clubs/scottish-sports-concussion-guidance/
Berlin Document and SCAT 5: https://www.sportphysio.ca/scat-5-consensus-statement-on-concussion-in-sport-the-5th-international-conference-on-concussion-in-sport-held-in-berlin-october-2016/