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General Definitions

1. Cerebral Concussion: Head-trauma-induced alteration in mental status that may or may not involve loss of consciousness. Concussions are graded in 4 categories.
2. Antegrade Amnesia: Memory loss of events following the impact.
3. Retrograde Amnesia: Memory loss for events preceding the impact. (the longer this interval the more severe the injury)

Second Impact Syndrome: Two concussions (bellringer or mild) in a short period of time
**50% of the cases of second impact syndrome result in death**
In almost every situation (sports injury) the blood pressure drops. The exception is head injuries in which the blood pressure rises. Consequently, it is important to monitor heart rate, respiration, blood pressure (serial reassessment every 5-10 minutes).
Signs demanding emergency attention

1. Increasing headache, nausea, or vomiting
2. Inequality of pupils
3. Progressive impairment of consciousness
4. Gradual rise in blood pressure (upon cessation of activity)
5. Diminution of pulse
**These signs and symptoms may indicate a subdural hematoma, which has a 70% mortality rate**

In the absence of a Certified Athletic Trainer or Physician, these guidelines should be used to determine whether an athlete can return to play:

No palpable tenderness

No swelling or discoloration

Can perform a full range of motion compared to the uninvolved side

Exhibits 90% strength compared to the uninvolved side

Lower extremity injuries - is able to run/jump without pain or limp

Upper extremity injuries - is able to perform a full swing/throw without pain