Combat Concussion

 

Whilst working as a medic covering a Taekwondo tournament in December 2017 I dealt with an incident of concussion. The competitor returned this year and I caught up with her to find out what happened after the event. I was not expecting the story that followed.

Carla, a black belt in Taekwondo, was competing in a sparring contest. She was wearing the appropriate safety equipment including head guard and gloves.

I became concerned about the competitor after she received a blow to her head. She became unsteady on her feet and so the bout was stopped. I removed her from the ring, and she began to complain of nausea and photosensitivity. We moved to a quieter area as the noise levels were beginning to become a problem for her. Following a full assessment my immediate impression was that she was concussed and should not continue in the tournament. 

The assessment revealed that it was difficult for her to answer certain questions. She answered Maddocks questions with no problems, it was when I began filling in her details on my treatment record that she struggled. She was unable to recall her phone number and revealed that she hadn’t been able to remember things for a few days after hitting her head on a concrete archway in a friend’s house.

She began to drop her level of consciousness and I became increasingly concerned, especially as this was her second head injury in the space of a week. Although haemodynamically stable I felt her dropping level of consciousness, nausea and photosensitivity meant I needed to refer Carla to a Doctor as a matter of urgency. I was concerned that this could be a serious head injury, possibly an intracranial bleed. I called 999 and unusually a doctor, nurse and paramedic were on the ambulance that was sent. 

A concussion was diagnosed by the doctor, with the advice to see her own GP on her return to Devon. She left Cardiff that evening with somebody keeping a close eye on her during the long car journey home.

I contacted her in the days following and she said she was feeling tired but generally better. When I caught up with her she told me of her difficult year since.

It was a few weeks after the initial diagnosis of concussion that her symptoms began to worsen. Whilst attending another Taekwondo tournament, as an observer, her friends became concerned when she became vacant and began slurring her words. They quickly took her to hospital.

Numerous scans were performed and thankfully there was no evidence of a life threatening bleed. Following a detailed examination of Carla and her ongoing symptoms a diagnosis of post-concussion syndrome was made. She continued to experience impaired vision finding herself unable to focus for any length of time. 

The extreme tiredness that she encountered restricted her everyday life including her ability to return to work. Concentrating for any length of time lead to exhaustion, even the simplest tasks became difficult. The making of simple decisions such as what to eat for tea were now a challenge. Reading and listening to music became impossible. It took four months before she was back at work as a classroom assistant. This was facilitated by her occupational health department who developed an activity/sleep schedule to aid her rehabilitation. 

Her mental health suffered, experiencing emotional discomfort the year since her injury. Thankfully she has been supported through this with counselling sessions and is now taking medication to ease her depression.

Although some symptoms remain, especially travel sickness and tiredness, things are improving and for the first time in over a year she has returned to exercise. Her involvement with Taekwondo continues, and whilst she has been advised not to spar again, working as an instructor Carla continues to inspire young people to take up the sport. 

When teaching on our First Aid for Sports and Exercise (FASE) and Sports Trauma Management Courses, we stress the importance of recognition and correct management of concussion.

Keeping up to date on any change in guidelines and published research allows us to keep our information current. Hearing directly from someone who has experienced a serious concussion has helped us to understand it’s long-term effects and the impact it can have. 

Kind thanks to Carla Dunne for allowing us to share her story.  

Hi guys, we'd just like to provide you with some links regarding current guidelines 2017.

Firstly this is the new SCAT5 assessment tool 2017; 

http://bjsm.bmj.com/content/bjsports/early/2017/04/26/bjsports-2017-097506SCAT5.full.pdf

Here is the child SCAT5 assessment tool 2017;

http://bjsm.bmj.com/content/bjsports/early/2017/04/26/bjsports-2017-097492childscat5.full.pdf

Also here is the consensus statement on concussion in sport from the Berlin conference november 2016;

http://bjsm.bmj.com/content/early/2017/04/26/bjsports-2017-097699

We have updated our Sports trauma management course to comply with the latest guidelines. 

There has also been updates from the British Thoracic Society

Here are the all guidelines;

https://www.brit-thoracic.org.uk/standards-of-care/guidelines/

Here are the guidelines for emergency oxygen use in ambulances, community and pre‐hospital settings;

https://www.brit-thoracic.org.uk/document-library/clinical-information/oxygen/2017-emergency-oxygen-guideline/web-appendix-5-summary-for-ambulance-and-prehospital-settings/

We hope this has been useful for you and we're happy to answer any questions you may have regarding these guidelines.

All Lubas course's are up to date with all current guidelines at the time of the course. 

Hi guys, we'd just like to provide you with some links regarding current guidelines 2017.

Firstly this is the new SCAT5 assessment tool 2017; 

http://bjsm.bmj.com/content/bjsports/early/2017/04/26/bjsports-2017-097506SCAT5.full.pdf

Here is the child SCAT5 assessment tool 2017;

http://bjsm.bmj.com/content/bjsports/early/2017/04/26/bjsports-2017-097492childscat5.full.pdf

Also here is the consensus statement on concussion in sport from the Berlin conference november 2016

http://bjsm.bmj.com/content/early/2017/04/26/bjsports-2017-097699

We have updated our Sports trauma management course to comply with the latest guidelines. 

There has also been updates from the British Thoracic Society

Here are the all guidelines;

https://www.brit-thoracic.org.uk/standards-of-care/guidelines/

Here are the guidelines for emergency oxygen use in ambulances, community and pre‐hospital settings;

https://www.brit-thoracic.org.uk/document-library/clinical-information/oxygen/2017-emergency-oxygen-guideline/web-appendix-5-summary-for-ambulance-and-prehospital-settings/

We hope this has been useful for you and we're happy to answer any questions you may have regarding these guidelines.

All Lubas course's are up to date with all current guidelines at the time of the course. 

What’s the problem?

 Developing the skills and knowledge to manage traumatic sports injuries is something that comes with real life experience, practice and dealing with emergencies first hand. As professionals working in sport we would never wish serious traumatic injuries upon any of the players we care for, but this causes a paradox in that how do we learn to manage these incidents if they do not occur regularly, if indeed at all

The Lubas Medical Sports Trauma Management course has been one method of preparing healthcare professionals for the eventuality of traumatic injuries in sport for over 15 years. A current Sports Trauma Management qualification is valid for three years, but after only a short period of time it is easy to forget the details of how to identify and effectively manage a range of complex, or potentially life threatening, injuries. 

 

 What’s the solution?

 As a healthcare professional it is your responsibility to keep your knowledge and skills up to date. Lubas Medical are now offering a new STM refresher course to run alongside our Sports Trauma Management course to enable you to do this. The one-day refresher course is an excellent opportunity for anyone who has completed the STM course within the previous 1-2 years to refresh and update skills and knowledge that may have been lost over time. 

 One day Sports Trauma Management Refresher

This new refresher course is advised, as best practice, to be completed between 12-18 months of your STM qualification, and recaps the fundamental skills and knowledge previously learnt

Taking a different approach!

This new 1 day STM refresher course will provide you with a current CPR + AED qualification. This falls in line with current Resuscitation Council (UK) guidelines that advise healthcare professionals to update their CPR + AED training at least annually. In addition to this the one-day STM refresher course will focus on scenario based learning, hands-on clinical skills and practical demonstrations covering traumatic injuries such as: 

 

  • The immediate management of Airway and/or Breathing issues (the use of airway adjuncts and oxygen) 

  • Management of acute MSK injuries, including fractures and dislocations (the use of splinting devices and Entonox) 

  • Head injuries and concussion 

  • Spinal injury management (collar measurement, log rolling, spinal stretchers and straps) 

 

There will be no change to the frequency of attendance on the 2 day STM course which will still need to be completed every 3 years to remain STM qualified. Lubas Medical hope that this one-day STM refresher will give those who cover sport the added practical experience to manage traumatic sports injuries safely and confidently, in between their 3 yearly STM requalification period 

 

 

Please follow the link for more information regarding the course or get in contact with us via email or phone.

http://www.lubasmedical.com/lubas-medical-courses/course-info/sports-trauma-management 

As a medical provider, you will have to deal with a medical emergency happening in your practice at some time.

When a patient is in your care you have a legal “duty of care” to that patient should they be taken ill. The unwell person may be a patient, relative, visitor or even a colleague and the emergency could take place anywhere within your practice or even outside the building.

To make your practice safe you should:

Plan

  • Discuss and agree the most appropriate and effective way to respond when someone is taken ill or injured:
  •  Discuss and agree the best place to keep your AED, emergency medical equipment and emergency drugs case.
  •  Decide what is the best way to communicate with your colleagues that their help is needed, such as alarm buzzers/bells, computer alerts or just shouting HELP!
  •  Who will be responsible for treating the patient?
  •  Who will call 999 and who will authorise when to call?
  •  Who will clear the waiting room of patients or can a room be made available to treat the unwell person away from the other patients?
  •  How will you manage an emergency outside the entrance to the building or in the car park?

PREPARE

Write a practice policy including:

  •  Location of medical equipment, who will check the equipment and how often.
  • A clear system for storing drugs and quickly identifying them when required.
  • Roles and responsibilities including assessing and treating the casualty, calling for help and ensuring patient confidentiality and dignity.
  •  Level of first aid cover required and how it will be provided at all times.
  •  Record keeping and restocking of drugs and equipment including frequency of checks.
  • Frequency of staff training.
  • Signage for location of AED, medical equipment and first aid trained staff.
  • Ensure that all staff are familiar with the practice emergency response policy and ensure it’s included during staff induction.

PRACTICE

Ensure staff practice their roles and know their responsibilities:

  • Undertake regular staff updates to familiarise all of the contents of your policy and individual roles and responsibilities.
  •  Ensure all staff are up to date with annual CPR, AED and Medical emergency training including scenario training within your practice, ensuring training is specific to dental practice staff.
  •  Encourage staff to regularly review the contents of the medical equipment and drug case, including oxygen and drug delivery.

PERFORM

When a medical emergency or injury occurs:

  •  Assess the patient and identify a team leader to ensure the most appropriate medical treatment is given.
  •  Record drugs and times treatment given to the patient.
  • Be aware of the dignity, confidentiality and privacy of the patient.
  •  Give full information when calling an ambulance as the ambulance response will be made from the information given. Update the ambulance service if the patient’s condition changes.
  •  If possible, identify a member of staff to meet the ambulance crew outside of the building when they arrive.
  •  Do not delay starting CPR and using an Automated External Defibrillator if indicated, the worst thing you can do in a cardiac arrest is nothing!
  •  After the incident take time to reflect on the practice response without individual criticism but to review the practice policy and debrief.
  •  Ensure all clinical reports are completed and equipment and drugs are re-stocked for the next emergency.

 

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