Physical Education - Concussion
Concussion involves a sudden blow to the head resulting in loss of
consciousness at the moment of injury with full recovery over the next few
minutes. It is important to emphasise that this loss of consciousness may
be so transient that it passes unnoticed, but the signs thereafter may be
the clue to diagnosis. Typically, there is pallor (pale skin) and a slowing
or shallowing of the pulse accompanied by shallow breathing.
There is loss of memory, particularly related to events around the time of
injury (usually a few minutes either side of this time). A headache and
nausea with or without vomiting ensues over the following hours. Usually,
concussion leaves no permanent disability, but with serious head injury a
fracture of the skull should be looked for and an x-ray taken if necessary.
There has been some evidence to suggest that EEG (electro-encephalogram or
electrical activity of the brain) disturbances may persist for some 6 weeks
after serious concussion, which implies the time taken to reach full
It must also be emphasised that concussion can be fatal if the blow to the
head has produced rupture of blood vessels around the brain, which produces
slow bleeding over a period of days or weeks. It is just such a haemorrhage
that produces the 'subdual haematoma ', which causes gradual loss of
consciousness and ultimately death.
The management of concussion demands immediate evacuation from competition
and full assessment by a qualified person. The injured athlete is not
allowed to return to sport, especially contact sport, until full recovery
can be demonstrated. In severe cases, this may mean a rest from competition
for 4 to 6 weeks.
If there is uncertainty as to whether a loss of consciousness has occurred
at the time of injury, it is simple enough to assess the athlete's
condition by asking questions, such as the score of the game, the current
time or date, a description of events around the time of injury (looking
for memory loss), together with a general impression of any personality
change such as aggression or confusion. If any doubt exists as to the
fitness of such an athlete, then further play or competition should not be
allowed until review and full recovery has been demonstrated.
To quote Hippocrates:
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