CONCUSSIONS

Primary Injury and structure involved:    Bruise to brain.  Direct blow to the head, chin or violent fall causing jarring effect through vertebral column to brain.

Grade 1  -  No loss of consciousness.  Athlete becomes dazed and disoriented  with balance problems and low              concentration but does not become amnesic.  Symptoms resolve within 15 minutes.
Grade 2  -  No loss of consciousness.  Minor confusion caused by post-traumatic amnesia.  Athlete will not be able to recall events that have occurred since the time of injury.  Unsteadiness, ringing in ears and dizziness may also occur.  A dull headache may follow.  Symptoms last more than 15 minutes.
Grade 3  -  Any loss of consciousness.  Includes all symptoms of Grade 2 plus retrograde amnesia.  Retrograde amnesia occurs when athlete is unable to recall events that occurred before the injury.  Mental confusion, balance disturbance and headache may also occur.  This is a medical emergency / referral.

Specific Evaluation Techniques:    ABC's, heart rate and respiratory rate, blood pressure, strength, motion, ocular tracking, direct pupil response, mental capacity, concentration status and balance tests.  Athlete should be tested every few minutes.

Treatment:   
Grade 1  -  Remove from contest until asymptomatic.
Grade 2  -  Remove from contest and disallow return.  Examine frequently for signs of evolving intracranial pathology.       Re-examine the next day.  May return to practice only after one full week without symptoms
(headache, dizziness, etc.).
Grade 3  -  Transport from field by ambulance.  May return to play after two full weeks without symptoms.    

References:
The American Academy of Neurology,  March 1997  48; 582-585
The Colorado Medical Society, 1990 (revised May 1991)
Robert C. Cantu, M.D., Physicians Sports Medicine 1986