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What is a Concussion?
A concussion is a type of brain injury that changes the way the brain normally works. A concussion is caused by a bump, blow, or jolt to the head.
Concussions can also occur from a fall or blow to the body that causes the head and brain to move rapidly back and forth. Even what seems to be a mild bump to the head can be serious.
What are the signs and symptoms of conssion?
Students who experience one or more of the signs and symptoms listed below after a bump, blow, or jolt to the head or body should be referred to a health care professional experienced in evaluating for concussion.
There is no one single indicator for concussion. Rather, recognizing a concussion requires a symptom assessment. The signs and symptoms of concussion can take time to appear and can become more noticeable during concentration and learning activities in the classroom. For this reason, it is important to watch for changes in how the student is acting or feeling, if symptoms become worse, or if the student just “doesn't feel right.”
SIGNS OBSERVED BY SCHOOL NURSES
• Appears dazed or stunned
• Is confused about events
• Answers questions slowly
• Repeats questions
• Can’t recall events prior to the hit, bump, or fall
• Can’t recall events after the hit, bump, or fall
• Loses consciousness (even briefly)
• Shows behavior or personality changes
SYMPTOMS REPORTED BY THE STUDENT
Thinking/Remembering:
• Difficulty thinking clearly
• Difficulty concentrating or remembering
• Feeling more slowed down
• Feeling sluggish, hazy, foggy, or groggy
Physical:
• Headache or “pressure” in head
• Nausea or vomiting
• Balance problems or dizziness
• Fatigue or feeling tired
• Blurry or double vision
• Sensitivity to light or noise
• Numbness or tingling
• Does not “feel right”
Emotional:
• Irritable
• Sad
• More emotional than usual
• Nervous
Sleep*:
• Drowsy
• Sleeps less than usual
• Sleeps more than usual
• Has trouble falling asleep
*Only as
How can concussions happen at school?
Children and adolescents are among those at greatest risk for concussion. Concussions can result from a fall, or any time a student’s head comes into contact with a hard object, such as the floor, a desk, or another student’s head or body. The potential for a concussion is greatest during activities where collisions can occur, such as during physical education (PE) class, playground time, or school-based sports activities.
Students may also get a concussion when doing activities outside of school, but then come to school when symptoms of the concussion are presenting. For example, adolescent drivers are at increased risk for concussion from motor vehicle crashes.
Concussions can have a more serious effect on a young, developing brain and need to be addressed correctly. Proper recognition and response to concussion symptoms in the school environment can prevent further injury and can help with recovery.
What can your School Nurse do?
1. Observe student for signs and symptoms of concussion for a minimum of 30 minutes.
2. Complete the Concussion Signs and Symptoms Checklist and monitor students consistently during the observation period.
3. Notify the student’s parent(s) or guardian(s) that their child had an injury to the head.
> If signs or symptoms are present: refer the student right away to a health care professional with experience in evaluating for concussion. Send a copy of the Concussion Signs and Symptoms Checklist with the student for the health care professional to review. Students should follow their health care professional’s guidance about when they can return to school and to physical activity.
> If signs or symptoms are not present:the student may return to class, but should not return to sports or recreation activities on the day of the injury. Send a copy of the Concussion
Signs and Symptoms Checklist with the student for their parent(s) or guardian(s) to review and ask them to continue to observe the student at home for any changes. Explain that
signs and symptoms of concussion can take time to appear. Note that if signs or symptoms appear, the student should be seen right away by a health care professional with experience in evaluating for concussion.
Again, remember your concussion ABCs:
A—Assess the situation
B—Be alert for signs and symptoms
C—Contact a health care professional
Information obtained from: http://www.cdc.gov/concussion/pdf/TBI_factsheet_NURSE-508-a.pdf
Enterovirus D68
§ Enterovirus D68 (EV-D68) is one of more than 100 non-polio enteroviruses and can cause mild to severe respiratory illness.
§ The number of reported cases of confirmed EV-D68 infection is on the rise in 46 states including Mississippi.
§ The virus can be found in an infected person’s respiratory secretions, such as saliva, nasal mucus, or sputum. EV-D68 likely spreads from person to person when an infected person coughs, sneezes, or touches a surface that is then touched by others.
§ In general, infants, children, and teenagers are the most likely to become ill with EV-D68.
a. Mild symptoms may include fever, runny nose, sneezing, cough, and body and muscle aches.
b. Severe symptoms may include wheezing and difficulty breathing.
c. More serious cases can experience complicated respiratory symptoms especially in children with asthma.
http://cdc.gov/non-polio-enterovirus/
http://www.cdc.gov/non-polio-enterovirus/about/EV68-infographic.html
http://www.cdc.gov/features/evd68/
Acute Neurologic Illness with Focal Limb Weakness of Unknown Etiology in Children
§ As of October 8, CDC has verified reports of 17 cases in the U.S, none in Mississippi, that meet the CDC case definition
§ Children are reporting a respiratory episode 2 weeks prior to symptoms.
§ Symptoms include extreme muscle weakness, paralysis and in some cases seizures.
§ There are investigations in process to determine possible links to the EV- D68.
http://www.cdc.gov/ncird/investigation/viral/sep2014.html
Ebola
§ The risk of an Ebola outbreak in the United States is very low with one travel related case and two associated infections of health care workers to date.
§ Ebola is transferred to the US through the travel of individuals that have been exposed/infected when in areas of known outbreak, currently West African countries.
§ Symptoms include: Fever (greater than 38.6°C or 101.5°F), severe headache, muscle pain, weakness, diarrhea, vomiting, abdominal (stomach) pain, unexplained hemorrhage (bleeding or bruising)
§ Symptoms may appear anywhere from 2 to 21 days after exposure to Ebola, but the average is 8 to 10 days.
§ Ebola is spread through direct contact with an infected person, the virus enters the body through broken skin or mucous membranes (example, the eyes, nose, or mouth). Direct contact is defined as contact with
a. Blood and body fluids (including but not limited to urine, saliva, sweat, feces, vomit, breast milk, and semen) of a person who is sick with Ebola
b. Certain objects (like needles and syringes) that have been contaminated with blood or body fluids of a person sick with Ebola.
c. Infected animals known to have been exposed to a person sick with Ebola.
§ Ebola is not spread through the air or by water, or in general, by food
http://msdh.ms.gov/msdhsite/_static/14,0,389.html
Responding to Viruses in Schools
1) Enterovirus D68- coughing, sneezing, runny nose, muscle aches. Most cases are mild. The more serious cases can experience complicated respiratory symptoms especially in children with asthma.
School response:
a. Have current individual Student Asthma Plans assessable for use
b. Provide hand washing instruction for teachers and students
c. Standard cleaning precautions
d. Separate ill students/staff and make appropriate medical referral
e. Engage school crisis management plan
2) Neurologic Illness- a history of respiratory illness in previous 2 weeks. Extreme muscle weakness, paralysis and seizure activity.
School response:
a. Provide hand washing instruction for teachers and students
b. Standard cleaning precautions
c. Separate ill students/staff and make appropriate medical referral
d. Engage school crisis management plan
3) Ebola- sudden onset of fever (greater than 101.5), headache, diarrhea, vomiting, and stomach pain. 2-21 days after exposure. Transmission occurs by direct contact with bodily fluids of an infected person.
School response:
a. Separate student/staff and make appropriate medical referral
b. Engage school crisis management plan
c. Follow CDC guidelines on cleaning and disposal of items soiled with bodily fluids from a person suspected of illness.
Questions to ask when enrolling students:
Have you recently lived/traveled outside the United States?
o If yes- then ask what country
§ If from West Africa then ask if they or someone in their household has had contact with anyone who was ill.
· If yes refer to the closest hospital and notify local health department, school administrator, and school nurse.
· Engage the school crisis management plan.
o If no then allow class attendance
Contact Information
Mississippi State Department of Health
§ Toll-free: 1-866-HLTHY4U (866-458-4948)
§ Public Health Emergencies: 601-576-7400
Mississippi Department of Education
§ Healthy Schools 601-359-1737
§ http://www.mde.k12.ms.us/healthy-schools
Additional Resources
Health in Action Lessons Dealing with Communicable Diseases:
http://lessonplans.movetolearnms.org/Search.aspx
§ Grades K-2:
My Hands are Clean (this lesson utilizes United Streaming)
Keeping the Flu Away
Safety and Medicines
Immunizations
Mr. Germ Head
§ Grades 3-5:
Do I Have to Wash My Hands?
§ Grades 6-8:
Don’t be Sick
Doctor, Doctor
§ Grades 9-12:
What’s Bugging You?
And you are…….
Clean Hands Are Happy Hands
Note: Even though these lessons are identified by grade level, a teacher can use the ideas and the information presented at any grade level that they feel is appropriate.