Emergent treatment of athletes with brain injury

The focus of this article is the early recognition and emergent treatment of severe or catastrophic traumatic brain injury. The pathophysiology and management of mild traumatic brain injury are reviewed extensively in other sections. Classification of head injuries can be based on anatomic location (epidural, subdural, intraparenchymal), mechanism of injury (coup, contrecoup, linear, rotational), distribution (focal or diffuse), and clinical presentation. Severe head injuries include epidural hematoma, subdural hematoma, intracerebral contusion/hemorrhage, traumatic subarachnoid hemorrhage, diffuse axonal injury, and malignant brain edema syndrome, either alone or in combinations. Protective equipment, regulations, and athletic training have improved dramatically as a result of the recognition of potentially devastating neurological injuries from competitive play. Physicians and other healthcare professionals have become integral members of organized sport and must advocate for the players' best interest. Once a neurological injury has been identified on field, it is imperative that prompt management and prevention of secondary injury occur. The goal of this article is to help provide a clear plan of action that is well thought out and rehearsed and that will lead to improved outcomes for the players, particularly those with severe or catastrophic brain injury.