Acute treatment of a traumatic brain injury is aimed at minimizing any secondary injury and maintaining life immediately after the traumatic event. The ultimate goals are to stop any intracranial bleeding, prevent an increase in pressure within the skull, control the amount of pressure if it does increase, maintain adequate blood flow to the brain and reduce the risk of a lack of oxygen supply to the brain.
There are three different stages of treatment for traumatic brain injuries. These include the acute phase where the patient is stabilized immediately after the injury; subacute phase to rehabilitate the patient to their potential to return to the community and the chronic phase to continue rehabilitation and treat any long-term impairment.
Initial treatments will be provided at the scene of the accident by emergency personnel if they are summoned. Occasionally individuals at an accident or athletic injury may determine that it is quicker to transport them self than it is to wait for an ambulance. However, more commonly an ambulance and paramedics are dispatched to treat the individual at the scene of the accident.
Treatments offered to the patient will vary with the type of injury. Commonly the head of the stretcher or bed will be slightly elevated and the neck of the individual kept straight. This position can help decrease any intracranial pressure by allowing blood and cerebral spinal fluid to drain using gravity. It is also very important to keep the neck and back straight to decrease in the risk of further injury to the spinal column that may have been suffered during the trauma.
Paramedics will never give fluids by mouth to an individual who has suffered a dramatic events area. The brain is like a sponge and will absorb any extra fluid that is given. Limiting fluids can help control swelling. Normally an IV is started at the scene of the accident in order to give the paramedics and doctors intravenous access for emergency medication.
Emergency medical professionals will also assess the individual\’s ability to breathe on their own. If the accident victim is unable to maintain oxygenation of their bodies then medical professionals and will assist until they reach the hospital.
Once admitted to the hospital, professionals will begin treatment of the brain injury. Using imaging studies and clinical assessments they will check for and surgically removed any life-threatening blood clots. Swelling in the brain (edema) is monitored and treated using either clinical evaluation or an intracranial monitor attached to the head. This swelling can cause an increase in intracranial pressure (ICP) that will squeeze the soft tissue of the brain against the skull. This will damage the brain tissue and cause further damage.
A buildup of fluid can also occur within the ventricle of the brain. This is called hydrocephalus and is treated using a shunt. This too is placed within the ventricle and then allows the cerebral spinal fluid to drain in the ventricles to shrink stores normal functions to brain cells.
Seizures can also occur in a week or month after a traumatic brain injury as the damaged brain cells begin to heal. These seizures can result in minor twitching of a finger or limb or lead to a complete loss of consciousness accompanied by involuntary movements of the entire body. Seizures are very dangerous during the acute treatment phase of a traumatic brain injury so most patients who have experienced a moderate or severe injury will receive medications are the first few weeks prophylactically.
Another important aspect of the acute care of a traumatic injury is monitoring of other medical problems. Abnormally high or low levels of sodium, calcium, sugar or other chemicals in the blood which are released during a traumatic event can worsen confusion and precipitate seizures. Individuals who suffer from a traumatic brain injury are also at high risk for infection, such as ammonia, urinary tract infections and sinusitis.
Medications which may be used to treat the brain injury can include diuretics to decrease the amount of water in the patient\’s body, anticonvulsants to prevent seizures, and barbiturates to help control intracranial pressure. Surgeons may also choose to use a shunt or ventricular drain placed in the ventricle to help control cerebral spinal fluid. A ventilator, machine used to support the patient\’s breathing, may be used to help control intracranial pressure.
Several surgeries may also be considered to help control the increased pressure within the brain. A craniotomy may be done to open the skull if there have been fractures in the bone, large blood clots or swollen brain tissue. Smaller blood clots will be removed to help relieve pressure or to place an intracranial pressure monitor. A bone flap removal is when a piece of bone is removed from the skull to make room and relieve pressure that is caused by swollen brain tissue.
Once patients are stabilized in the acute setting they will be transferred to a subacute dramatic brain injury treatment center where their rehabilitation will be initiated. At the specialized care facilities medical staff will fully evaluate the patient\’s impairments, disabilities and probability of recovery. Doctors will also outline a course of treatment and health patients and their families build the right team of medical professionals necessary for successful rehabilitation.
RESOURCES
Trauma.org: Acute Management of Traumatic Brain Injury
Brain Trauma Foundation: Guidelines for the Management of Severe Traumatic Injury
Chinese Journal of Traumatology: Is Management of Acute Traumatic Brain Injury Effective?