Brain Injuries
Treatment Options
Medical care usually begins when paramedics
or emergency medical technicians arrive on
the scene of an accident or when a TBI
patient arrives at the emergency department
of a hospital. Because little can be done to
reverse the initial brain damage caused by
trauma, medical personnel try to stabilize
the patient and focus on preventing further
injury. Primary concerns include insuring
proper oxygen supply, maintaining adequate
blood flow, and controlling blood pressure.
Since many head-injured patients may also
have spinal cord injuries, the patient is
placed on a back-board and in a neck
restraint to prevent further injury to the
head and spinal cord.
Medical personnel assess the patient's
condition by measuring vital signs and
reflexes and by performing a neurological
examination. They check the patient's
temperature, blood pressure, pulse,
breathing rate, and pupil size and response
to light. They assess the patient's level of
consciousness and neurological functioning
using the Glasgow Coma Scale.
Imaging tests help in determining the
diagnosis and prognosis of a TBI patient.
Patients with mild to moderate injuries may
receive skull and neck X-rays to check for
bone fractures. For moderate to severe
cases, the gold standard imaging test is a
computed tomography (CT) scan, which creates
a series of crosssectional X-ray images of
the head and brain and can show bone
fractures as well as the presence of
hemorrhage, hematomas, contusions, brain
tissue swelling, and tumors. Magnetic
resonance imaging (MRI) may be used after
the initial assessment and treatment of the
TBI patient. MRI uses magnetic fields to
detect subtle changes in brain tissue
content and can show more detail than X-rays
or CT. The use of CT and MRI is standard in
TBI treatment, but other imaging and
diagnostic techniques that may be used to
confirm a particular diagnosis include
cerebral angiography, electroencephalography
(EEG), transcranial Doppler ultrasound, and
single photon emission computed tomography (SPECT).
Approximately half of severely head-injured
patients will need surgery to remove or
repair hematomas or contusions. Patients may
also need surgery to treat injuries in other
parts of the body. These patients usually go
to the intensive care unit after surgery.
Sometimes when the brain is injured swelling
occurs and fluids accumulate within the
brain space. It is normal for bodily
injuries to cause swelling and disruptions
in fluid balance. But when an injury occurs
inside the skull-encased brain, there is no
place for swollen tissues to expand and no
adjoining tissues to absorb excess fluid.
This increased pressure is called
intracranial pressure (ICP).
Medical personnel measure a patient's ICP
using a probe or catheter. The instrument is
inserted through the skull to the
subarachnoid level and is connected to a
monitor that registers the patient's ICP. If
a patient has high ICP, he or she may
undergo a ventriculostomy, a procedure that
drains cerebrospinal fluid (CSF) from the
ventricles to bring the pressure down. Drugs
that can be used to decrease ICP include
mannitol or barbiturates.
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