Initial Emergency Room Care and Hospitalization
Initial Emergency Room Assessment
For persons with moderate to severe TBI, initial emergency room evaluation is critical and will typically include the following goals:
- To stabilize the person's breathing, pulse, and blood pressure.
- To assess the severity of the brain injury, determine the risk of further deterioration, and identify other potentially life threatening injuries.
- To assess involvement of alcohol or illicit substances.
- This is critical because symptoms of intoxication may mask an underlying brain injury.
Specific evaluation techniques include:
- history taking
- physical examination
- neurological exam (e.g., including Glasgow Coma Scale)
- CT scan
Potential Emergency Room Interventions
The goal of initial intervention is medical stabilization. Interventions may include:
- Insertion of an endotracheal tube to protect the airway and prevent aspiration.
- Placement of intravenous lines, which also allow for collecting blood samples to assess for blood count, blood sugar, and alcohol levels.
- Administration of sedative and/or muscle relaxant drugs if artificial ventilation is needed and/or the person is at risk for accidental self-harm due to confusion/agitation.
- Artificial ventilation may be used if the person is experiencing breathing difficulties.
- Surgery may be used, generally for two primary reasons:
- To relieve pressure on the brain due to bleeding or swelling of the brain.
- To prevent infection following penetrating brain injuries (e.g., when an object breaks through the skull and directly injuries the brain).
- Insertion of a device for monitoring intracranial pressure. This allows for ongoing monitoring of brain edema and swelling; if significant swelling occurs, surgery may be needed.
- Feeding via nasogastric tube may be started around 72 hours after injury in comatose patients.
Individuals who have sustained a moderate or severe TBI may be transferred to the hospitalâ€™s intensive care unit (ICU) for ongoing monitoring.
Once the immediate medical crisis (related to the TBI and/or other medical injuries) has passed, the injured person is typically transferred to a non-ICU unit in the hospital for continued monitoring and treatment planning.
After the injured person is medically stabilized, he/she may be transferred to an Acute Rehabilitation Hospital or may be discharged to home, depending on the nature of symptoms experienced after the injury.