NATA-BOC Head and Spine Injury Management Questions and Answers 1 — Questions and Answers
Question 1: An athlete sustains a blow to the head and is removed from play. After being asymptomatic for 10 minutes, they receive a second, minor impact and rapidly deteriorate, showing signs of brainstem failure. This catastrophic event is best described as:
- Post-concussion syndrome
- An epidural hematoma
- Second impact syndrome (Correct answer)
- A diffuse axonal injury
Correct answer: Second impact syndrome
Second impact syndrome (SIS) is a rare but often fatal condition where a second head injury occurs before the brain has recovered from an initial concussion. This second impact causes rapid, diffuse cerebral edema and increased intracranial pressure, leading to brain herniation and failure. The key features are the two separate impacts and the rapid, catastrophic decline after the second one, which may be minor.
Question 2: When managing a football player with a suspected cervical spine injury, which of the following is the MOST appropriate immediate action regarding their equipment according to NATA position statements?
- Remove the helmet immediately to assess the airway, but leave the shoulder pads on.
- Remove both the helmet and shoulder pads on the field to allow for chest compressions.
- Leave both the helmet and shoulder pads in place and stabilize the head and neck in the position found.
- Remove the face mask, but leave the helmet and shoulder pads on unless airway access is compromised. (Correct answer)
Correct answer: Remove the face mask, but leave the helmet and shoulder pads on unless airway access is compromised.
NATA guidelines recommend that for equipment-laden athletes with a suspected cervical spine injury, the face mask should be removed to provide access to the airway, but the helmet and shoulder pads should be left in place. Removing either the helmet or shoulder pads independently can cause dangerous movement and compromise spinal alignment. The equipment should only be fully removed by trained professionals in a controlled environment, like an emergency department, unless it is absolutely necessary to save the athlete's life.
Question 3: A 19-year-old collegiate soccer player is involved in a head-to-head collision. They are alert (GCS 15), have no midline cervical spine tenderness, and are ambulatory on the sideline. However, they report numbness and tingling in their right arm. According to the Canadian C-Spine Rule, what is the appropriate next step?
- Perform active range of motion testing of the neck.
- Clear the athlete from a cervical spine injury as they are ambulatory.
- Refer the athlete for radiographic imaging of the cervical spine. (Correct answer)
- Apply a cervical collar and have them rest for 30 minutes before reassessing.
Correct answer: Refer the athlete for radiographic imaging of the cervical spine.
The Canadian C-Spine Rule is a decision-making tool to determine the need for cervical spine radiography. The presence of paresthesias (numbness and tingling) in the extremities is considered a high-risk factor that mandates radiographic imaging, regardless of other low-risk findings like being ambulatory or having no midline tenderness. Therefore, active range of motion testing is contraindicated, and the athlete requires immediate referral for imaging.
Question 4: Which of the following signs is classically associated with an epidural hematoma following a head injury?
- A lucid interval followed by rapid deterioration (Correct answer)
- Gradual onset of headache and confusion over several days
- A crescent-shaped finding on a CT scan
- Symptoms caused by tearing of bridging veins
Correct answer: A lucid interval followed by rapid deterioration
An epidural hematoma, typically caused by an arterial bleed between the skull and dura mater, is classically characterized by a brief loss of consciousness, followed by a period of lucidity (the 'lucid interval'), and then a rapid decline in neurological function. This rapid deterioration is due to the fast accumulation of arterial blood. A gradual onset is more typical of a subdural hematoma, which is also associated with crescent-shaped findings on CT and tearing of bridging veins.
Question 5: An athletic trainer is conducting a sideline concussion assessment using the Sport Concussion Assessment Tool 5 (SCAT5). Which of the following components is used to assess the athlete's immediate memory?
- Asking the athlete to recite the months in reverse order.
- The Modified Balance Error Scoring System (mBESS).
- Performing a delayed word recall test after 5 minutes.
- Giving the athlete a list of 10 words and asking them to repeat as many as possible. (Correct answer)
Correct answer: Giving the athlete a list of 10 words and asking them to repeat as many as possible.
The SCAT5's cognitive screening section, specifically the Standardized Assessment of Concussion (SAC) portion, includes a test for immediate memory where the examiner reads a list of 10 words and the athlete is asked to repeat them immediately. This is repeated for three trials. Reciting the months in reverse order assesses concentration. The mBESS evaluates balance. The delayed word recall tests recent memory, not immediate recall.
Question 6: According to the most recent NATA position statements and return-to-play guidelines for sport-related concussion, what is the recommended first step in the exertional progression once an athlete is symptom-free at rest?
- Sport-specific, non-contact training drills.
- Light aerobic exercise such as walking or stationary cycling. (Correct answer)
- Moderate-intensity weightlifting.
- A 24-48 hour period of complete cognitive and physical rest.
Correct answer: Light aerobic exercise such as walking or stationary cycling.
The graduated return-to-play (RTP) protocol begins after an initial rest period (24-48 hours post-injury) and once the athlete is asymptomatic. The first step in the exertional phase is light aerobic activity designed to increase the heart rate without provoking symptoms. Examples include walking, light jogging, or stationary cycling. Sport-specific activities and resistance training are introduced in later stages of the progression.
NATA-BOC Head and Spine Injury Management Questions and Answers 1
An athlete sustains a blow to the head and is removed from play.
After being asymptomatic for 10 minutes, they receive a second, minor impact and rapidly deteriorate, showing signs of brainstem failure.
This catastrophic event is best described as: