In The Hospital

IN The Hospital - What to Expect

Getting a prognosis

A variety of outcomes are possible following a severe brain injury, everything from death to extremely good recovery. In the early stages following the injury, doctors may use the following tests to determine which outcome is likelier:

The person’s score on the Glasgow Coma Scale. A lower score indicates a worse outcome. Computed tomography (CT) scans or magnetic resonance imaging (MRI) of the brain can show the extent and type of brain damage. They can also reveal the presence or absence of other possible injuries caused by a lack of blood flow.

Measurements of pressure inside the skull. Elevated pressure is typically associated with a worse outcome.

The Glasgow Coma Scale

Best eye response (E)
4. Spontaneous
3. To speech
2. To pain
1. No eye opening

Best verbal responsive (V)
5. Oriented
4. Confused
3. Inappropriate words
2. Incpmprehenssible sounds
1. No verbal response

Best motor response (M)

6. Obeys commands
5. Responds purposefully to pain
4. Withdraws from pain
3. Flexes in response to pain
2. Extends in response to pain
1. No motor response

Doctors add the scores from all parts of the test. A patent with a total score of less than 8 is considered to be in a coma.

Measurements of the electrical activity of the brain, such as electroencephalograms (EEGs) may reveal the degree of damage.

Another important measurement is time: The longer a person stays in a coma or vegetative state, the worse the likely extent of the damage and, therefore, the worse the outcome.

Getting Treatment

Appropriate treatment should begin at the time of the accident or incident. A brain injury is an emergency. Emergency personnel should attend to the person with a brain injury as soon as possible.

After receiving emergency medical treatment, persons with a moderate to severe brain injury may be admitted to a hospital’s inpatient intensive care unit (ICU). The goals in the inpatient ICU include making the patient stable and preventing a medical crisis. Some preventive rehabilitation may be tried in the ICU, such as body positioning splinting and range of motion (a therapist moves the persons limbs).

The person with the brain injury in the ICU may be unconscious, in a coma or medically unstable. To provide life‑sustaining medical care, the health care staff may have many tubes, wires and pieces of medical equipment attached to the person with a brain injury.

Medical equipment used in the ICU

Ventilator (aka respirator):
Machine that helps a person breathe.

A person who has a brain injury may be unable to breathe on his or her own.

To use a ventilator, a tube is placed through the person’s mouth to the breathing passage (aka trachea or windpipe). This procedure is called intubation.

Intubation with the use of a ventilator allows a person to breathe and receive oxygen, which is necessary to live.

Intravenous (IV) lines:
Tubes placed in a person’s veins that deliver medications and fluids to their body.

Arterial lines:
Tubes placed in a person’s arteries that measure blood pressure.

Foley catheter:
Used to collect and monitor a person’s urine.

A person who has a brain injury may be unable to control his/her bladder.

A rubber tube is put into a person’s bladder. This allows urine to move from the bladder, through the tube, and to a container at the end of the tube.

Nasogastric (NG) tube:
Used to deliver medication and nutrients directly to a person’s stomach.

A tube is placed through a person’s nose or mouth and run through the swallowing passage to the stomach.

Electrocardiography (EKG.):
Machine that monitors a person’s heart. Wires with sticky ends are placed on the body.

lntracranial pressure (ICP) monitor:
Device attached to a person’s head with a monitor that indicates the amount of pressure in the brain.

When the brain is injured, it may swell.

When the brain swells, the brain has no place to expand. This can increase the pressure within the skull.

If the brain swells and has no place to expand, this can cause brain tissues to press together, causing further injury.

Pulse oximeter:
Small clamp-like device placed on a person’s finger, toe or earlobe. The pulse oximeter measures the amount of oxygen in the blood stream.

Tips for Families and Caregivers

You may find it emotionally devastating when visitation restrictions do not allow you to always be by your loved one’s side. But limiting visitation lets the staff carry out many necessary procedures. As patients stabilize, they are usually moved to a normal patient room where visitation rules are more relaxed.

Family members gathered in a waiting room or the patient’s room can put their time to good use by deciding who is the most available for daily updates from the medical and nursing staff. Start a notebook for this information; collect business cards from the physicians treating your family member; and record questions. This information can be passed along to other family members and friends.

Later days in the Hospital

Once the individual is stable, the focus of treatment may be rehabilitation.

Trauma physicians will no longer be involved in the care of the patient as he/she gets better. Some of the patient’s mannerisms and characteristics will begin to reemerge and therapists will evaluate and work on those functions lost to the injury.

Some individuals become agitated during this time. This can be very frightening for family members, but agitation in this early period is actually a positive sign that the brain is beginning to recover. Also, do not be discouraged if physical recovery seems to be happening faster than intellectual recovery.

Setbacks will become less frequent as your family settles into a routine of visitation and hopefulness. Be prepared to speak with hospital social workers, insurance case managers, rehabilitation evaluators and representatives from state agencies or trust funds about benefits and payment of claims, eligibility for state-provided programs, legal issues and discharge options. Be sure to write important information down when discussing issues with professionals. It can help you accurately share information with others later.