Moderate to Severe TBI
Immediate treatment is designed to take care of any life-threatening injuries right after the trauma, providing the first line of care for the patient. Rescue or emergency personnel work to unblock airways, help with breathing, and keep blood circulating. They work to administer oxygen as quickly as possible after the injury to help reduce the risk of additional damage to the brain. Cardiopulmonary resuscitation, or CPR, may also be necessary. Steps are taken to control blood loss, replace lost blood with fluids, and prevent or treat other complications.
Immediate treatment continues when the patient arrives at a medical facility. Since the normal pressure inside the skull may increase after an injury, one important step taken is to measure that pressure. This pressure is known as intracranial pressure, or ICP. Because the increase in ICP can be dangerous, it needs to be closely watched using an ICP monitor.
In some cases of moderate to severe TBI, surgery may be needed to reduce the intracranial pressure and provide space for any swelling of the brain. There are two kinds of surgery that are often used to do this. One of these involves the temporary removal of part of the skull, in the form of a bone flap. This procedure is called a craniotomy. The brain can then be accessed for treatment, pressure on the brain is relieved, and the bone flap is replaced.
If the bone is not replaced immediately, the procedure is called a craniectomy. In this case, the original bone may be replaced at a later time, or an artificial replacement, made specifically for the patient, may be used. While the bone flap is not in place, many patients wear a helmet to protect their brain.
Seizures can occur seconds, weeks, or years after a TBI. A seizure can be a minor twitching of one finger, arm or leg, or a complete loss of consciousness with uncontrolled shaking of the entire body. Seizures can be particularly dangerous during the immediate and intermediate phases of treatment. For this reason, most patients with moderate to severe TBI receive anti-seizure medication for at least a week after the injury.
Another important part of both immediate and intermediate care is the prevention of other medical problems that can happen along with the brain injury. One concern is that the patient’s blood chemistry can become unbalanced, making confusion worse and possibly causing seizures. Another concern is that patients can get infections that can be very serious. Medications and other therapies can be used to treat or control these conditions.