Head, Neck, and Facial Injuries including Concussion
Concussion assessment
Understand the sport concussion assessment tools (SCAT-type evaluation), including symptom checklist, cognitive testing (SAC), balance (BESS), and neurologic exam. Concussion is a clinical diagnosis-no single test confirms it. Trap: normal imaging does not exclude concussion; CT is for ruling out intracranial hemorrhage, not diagnosing concussion.
Management and return to play
Key principles: physical and cognitive rest initially, then gradual return to learn before return to play. Use a stepwise exertion protocol (light aerobic, sport-specific, noncontact, contact, full). Any recurrence of symptoms means stepping back. Red flags requiring emergency evaluation include worsening headache, repeated vomiting, seizure, focal deficit, drowsiness, and unequal pupils. Second impact syndrome is rare but catastrophic.
Facial and neck injuries
Know nasal fracture, orbital blowout fracture (diplopia, restricted upward gaze, enophthalmos), and dental avulsion (reimplant within minutes, store in saline or milk). Cervical spine precautions take priority in any head injury with neck pain or altered mental status.
Rule of thumb
Return to learn before return to play; never advance a stage while symptomatic. For a knocked-out tooth, reimplant or store in milk/saline and see a dentist urgently.