When a TBI patient enters at the emergency department of a hospital or when paramedics or emergency medical technicians (EMT) arrive on the scene of an accident, medical care typically sets in motion.
Medical personnel make an effort to stabilize the patient and are carefully cautious on avoiding further damage for the reason that only little can be made to reverse the preliminary brain damage caused by trauma.
Including insuring appropriate oxygen supply to the brain and the rest of the body, keeping adequate blood flow, and controlling blood pressure to the normal range, are the most important concerns.
To make certain that the patient is breathing or having appropriate oxygen supply, emergency medical personnel may have to open the patient’s airway or perform other procedures related to its benefit.
To keep the heart pumping blood to the body they may in addition perform cardiopulmonary resuscitation (CPR); and try to control or stop any form of bleeding, they may treat other injuries.
Medical professionals take a lot of care in moving and transporting the patient to the nearest hospital for the reason that a lot of head-injured patients may have spinal cord injuries. The patient is placed and positioned on a back-board and in a neck brace restraint. These devices prevent extra injury to the head and spinal cord by immobilizing the victim.
In moving and transporting head-injured patients’ to a nearest health treatment facility, medical professionals take many precautions.
To immobilize and/or to avoid further injury to the patient back-boards and neck brace/restraints are used.
Medics assess the patient’s condition by taking vital signs and measuring reflexes and by performing a neurological examination the instant the head-injured patient is stabilized.
In reaction to light, they check the patient’s temperature, blood pressure, pulse, breathing rate, the size of the pupils, and how it responds to light.
Utilizing a standardized, 15-point test, the Glasgow Coma Scale assesses the patient’s level of consciousness and neurological functioning in order to establish the severity of the patient’s brain injury by means of three measures: such as eye opening, best verbal response, and best motor response.
Glasgow Coma Scale
The eye opening with four scores:
4 – Signify that the patient can open and fully control his eyes spontaneously.
3 – Given if the patient is able to open and control his eyes on verbal command.
2 - Signifies that the patient opens his eyes barely in reaction to painful stimuli.
1 – Scored to a patient who does not open his eyes in response to any stimulus.
The best verbal response with five scores:
5 – Signify that the patient is oriented and can speak coherently.
4 – Score given if the patient is disoriented however can speak coherently.
3 – Signifies that the patient utters inappropriate words or incoherent speech.
2 – Score given if the patient creates incomprehensible sounds.
1 - Signify that the patient present no verbal response by any means.
The best motor response with six scores:
6 – Signify that the patient can fully move his extremities (arms and legs) in response to verbal commands.
5 – Score given if patient localizes pain
4 – Given if patient withdraws/flexes to pain
3 – Score given if patient that decorticates manifesting flexor posture to pain
2 – Score for patient that decorticates with extensor posture to pain
1 – Signify that the patient manifest no movement in response to any stimuli
To find out the patient’s overall condition the outcome of the three tests are summed up. An overall score of 13 to 15 signify a mild head injury, 9 to 12 designates a moderate head injury, and 3 to 8 points out a severe head injury.
For a TBI patient, imaging tests in establishes the diagnosis and prognosis from an injury. To check for bone fractures or spinal instability, patients with mild to moderate injuries possibly will undergo skull and neck X-rays.
Until medical personnel are confident that there is no possibility of spinal cord injury the patient must remain immobilized in a neck brace and back restraint.
The gold standard imaging test which is a computed tomography (CT) scan, is for moderate to severe cases of injury. The presence of hemorrhage, hematomas, contusions, brain tissue swelling, and tumors CT scan makes a series of cross-sectional X-ray images of the head and brain and can be evidence for bone fractures.
Subsequent to the preliminary assessment and treatment of the TBI patient Magnetic resonance imaging (MRI) may be utilized. Compared to X-rays or CT scan, MRI uses magnetic fields to identify subtle changes in brain tissue content and can confirm more details.
Regrettably, in view of the fact that it is time-consuming and is not available in every hospital MRI is not perfect for routine emergency imaging of TBI patients.
Repair hematomas or contusions are in half of the severely head-injured patients and will need to undergo surgical procedure. To take care of injuries in other parts of the body patients may need additional surgery.
Subsequent to surgery these patients are typically admitted to the intensive care unit (ICU) for better monitoring and management and in preventing incidents particularly infection, ivolved in early recovery.
Occasionally, swelling takes place and fluids build up within the brain space or cavity when the brain is injured. In fluid balance it is common for bodily injuries to cause swelling and disturbances.
On the other hand, there is no area for swollen tissues to expand and no adjacent tissues to absorb excess fluid when an injury comes up within the skull-encased brain. This increased pressure is known as intracranial pressure (ICP).
Patients are carefully monitored by medical personnel. The ICP device/apparatus through the used of a probe or catheter is introduced through the skull to the subarachnoid level that registers the patient’s ICP when it is connected to a screen monitor.
He or she may submit to a ventriculostomy if a patient has increased ICP, a procedure that draws off cerebrospinal fluid (CSF) to bring the pressure down from the brain.
Including mannitol or barbiturates, these medications can be used to reduce ICP, even though the safety and effectiveness of the latter are unknown.
Images of the head and brain can be completed by means of a computed tomography scanner. To be of assistance in determining the prognosis of TBI patients, this imaging test can be evidence for bone fractures, hemorrhages, hematomas, contusions, brain tissue swelling, and even tumor growths.