Testing and Treatment

What Medical Care Should a TBI Patient Receive?

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 to the brain and the rest of the body, maintaining adequate blood flow, and controlling blood pressure. Emergency medical personnel may have to open the patient's airway or perform other procedures to make sure the patient is breathing. They may also perform CPR to help the heart pump blood to the body, and they may treat other injuries to control or stop bleeding. Because many head-injured patients may also have spinal cord injuries, medical professionals take great care in moving and transporting the patient. Ideally, the patient is placed on a back-board and in a neck restraint. These devices immobilize the patient and prevent further injury to the head and spinal cord.

(from National Institute of Health at http://www.ninds.nih.gov/disorders/tbi/tbi.htm)

Tests to Evaluate TBI

• Neurological Exam: A series of questions and simple commands to see if the person with a brain injury can open their eyes, move, speak and understand what is going on around them. For example: What is your name? Where are you? What day is it? Wiggle your toes. Hold up two fingers. A standard way to describe responses may be used. Most hospitals use the Glasgow Coma Scale or Rancho Levels of Cognitive Functioning. You can read about these scales and what the scores mean below.
• X-ray: A picture that looks at bones to see if they are broken (fractured). It can also be used to take a picture of the chest to look at the lungs. This test may be done at the bedside or in the X-ray department and takes between five and 30 minutes to complete.
• CT Scan (CAT Scan): An X-ray that takes pictures of the brain or other parts of the body. The scan is painless but the individual must lie very still. The test takes 15 to 30 minutes to complete.
• MRI (Magnetic Resonance Imaging) Scan: A large magnet and radio waves are used, instead of X-rays, to take pictures of the body’s tissues. It is painless but noisy. The machine is shaped like a long tube. The individual must lie still on a flat table in the middle of the machine. The test takes about 60 minutes to complete.
• Angiogram:  A test to look at the blood vessels in the brain. Using a catheter, or small flexible tube, dye is put into an artery (usually in the groin) that supplies blood to the brain. This test can tell if the blood vessels have been damaged or are spasming. The test takes one to three hours.
• ICP Monitor: A small tube placed into or just on top of the brain through a small hole in the skull. This will measure the pressure inside the brain (intracranial pressure).
• EEG (Electroencephalograph): A test to measure electrical activity in the brain.  Special patches called electrodes are applied to the head to measure the activity. The test is painless and can be done at the bedside or in the EEG department.
• Neuropsychological battery: Neuropsychologists test thinking, memory, judgment, emotions, behavior and personality. This information can be used to help guide treatment. It will also help determine the amount of supervision that patients need when they leave the hospital.

Coma, a state of unconsciousness from which a person cannot be aroused, is common following a brain injury. It is difficult for health care professionals to predict how long it may last. Characteristics of a patient in a coma include the following.

• Eyes are closed; patient looks asleep
• Does not speak or respond when spoken to
• Does not follow spoken commands
• Unaware of surroundings
• Does not respond to touch, sound or light.  It is not known how much a patient in a coma hears, understands or feels. Families, visitors and staff should talk and behave as though the person can hear and understand