Initial Emergency Room Care and Hospitalization

Initial Emergency Room Assessment

Photo of a red emergency room sign with an ambulance in the backgroundFor persons with moderate to severe TBI, initial emergency room evaluation is critical and will typically include the following goals:

  1. To stabilize the person's breathing, pulse, and blood pressure.
  2. To assess the severity of the brain injury, determine the risk of further deterioration, and identify other potentially life threatening injuries.
  3. To assess involvement of alcohol or illicit substances.
    1. 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
  • MRI
  • x-rays

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.

Initial Hospitalization

Individuals who have sustained a moderate or severe TBI may be transferred to the hospital’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.

 

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This project was supported, in part, by grant number 90TBSG0040-03-00, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points or view or opinions do not, therefore, necessarily represent official Administration for Community Living policy, nor positions of Curators of the University of Missouri, UMKC, any partners, or additional funding sources.