In addition to the primary brain injury, there can be further damage to the brain from swelling of the brain and bleeding inside the skull. Monitoring this pressure is a major concern immediately after the injury. Because our brain controls our body, a brain injury can result in the need for machines or special medical care to take over some or all the bodily functions that the brain would normally control.
Problems caused from bleeding and swelling may need acute medical care, which is usually provided while the patient is in an intensive care unit (ICU). Acute medical care can include medical care or surgery for some or all the following problems:
• Pressure inside the skull – Bleeding inside the skull or swelling of brain tissue may need monitoring of the pressure inside the skull, called ICP (intracranial pressure) monitoring. This procedure measures the pressure of the brain, cerebrospinal fluid, and blood against the skull. ICP monitoring can detect small changes in pressure before physical danger signs can develop.
A surgical opening into the skull, called a craniotomy, may be needed to relieve the pressure, repair the brain or skull, or remove fractured bone. If your loved one has surgery, part of his head may be shaved. The incision may have stitches and be covered with bandages for protection. An incision into a cerebral ventricle (ventriculostomy) may be needed to help drain excess cerebrospinal fluid.
• Breathing problems – A major concern for patients that also have a chest or lung injury or patients in a coma is keeping their nose, mouth, and throat clear so they can breathe and get oxygen. A brain injury increases
the body’s need for oxygen for healing. In order to keep the airway clear, the patient may need a tracheostomy tube. A ventilator may be needed to help the patient breathe.
• Nutrition problems – The brain controls the muscles used for swallowing. Problems with swallowing can keep the patient from getting the nutrients and water needed for healing and sustaining life. The patient may need a feeding tube to give proper nutrition and to maintain a proper weight. In addition, the stomach continues to make acids that can damage the stomach lining and cause stomach ulcers if the acids are not removed. A nasogastric tube that enters the nose and goes into the stomach can be used to remove these acids. Medicines may also be used to help prevent stomach ulcers.
• Problems with bowel and bladder control can require diapers or a catheter as well as monitoring the intake and output of fluids and solids.
• Skin problems can be the direct result of the accident or injury (such as cuts or scrapes) or can result from the patient’s lack of mobility (such as pressure sores). Pressure sores happen when the skin breaks down due to constant pressure against the skin.
• Infections – It is not unusual for people with brain injuries to get infections, such as pneumonia; infections of the bladder, skin or blood; or infections of the brain or cerebrospinal fluid (called meningitis), which may require antibiotic treatment.
• Orthopedic problems – If there are other injuries, such as broken bones or cuts from a car wreck, the injured person may have splints, casts, braces, or need special surgery. Bruises, cuts, stitches, bandages, and blood are all common.
• Cognitive problems – The person may have problems with awareness, communication, behavior, and responding to stimuli.
• Other common problems include:
– Blood clots forming in the legs or lungs.
– Urinary tract infections and kidney stones.
– Uncontrollable blood pressure.
– Muscle tone and spasticity problems resulting from the brain injury may require a cast or splint to prevent long-term problems.
– Pneumonia— if the patient develops pneumonia, treatment will be needed to loosen and remove mucus from the lungs.
“Talk to them, play the music they like, and let younger children help, too. You never know what may trigger a response. Show them your love and your smiles, not your tears. Stay positive.”
– Mother of a 17-year-old who survived an eight-week coma when the van he was riding in was hit broadside by a drunk driver.
Table of Contents
• What is a Brain Injury?
• How Bad Is It?
• How the Brain Functions
• Common Problems During Early Recovery
• The Intensive Care Unit (ICU)
• Understanding Coma
• How Does an Injured Brain Heal?
• How You Can Help With Recovery
• Where Will the Journey Go From Here?
• How Will I Ever Get Through This?
• Where to Go for Help
• Books for Families Coping With Brain Injury