Brain Injuries During Medical Emergencies
When some one falls, gets hit by a ball, bat or object, is involved in a vehicle crash and sustains a concussion, medical attention is needed because a concussion is a brain injury, not a bump to the head or just a "ding". Though a person may fully recovery from a brain injury which occurred following a fall, an impact or a collision, there are secondary brain injuries or insults that can occur. For example, if the incident causes someone to have a brain bleed, the blood can cause a rise in the intracranial pressure. This can occur because the skull is not expandable and the additional blood (or sometimes cerebral spinal fluid) fills up the space between the brain and the skull. Since the skull cannot expand, the additional fluid can exert increased harmful pressure against the brain. If left untreated, the increased pressure can cause diminution of brain cell blood flow and reduced oxygen to the areas of the brain. Untreated, the pressure can cause brain cells to die leaving the individual with permanent brain damage.
At the emergency room, staff will evaluate the patient's reported symptoms and signs to ascertain whether the patient's mental status is changing. Under certain conditions, a CT scan will be performed to see if there is a brain bleed, sometimes referred to as a subdural hematoma (SDH). If found on diagnostic tests, doctors can decide whether or not medication and monitoring is appropriate, or if surgical intervention is necessary. Surgical intervention can include insertion of an ICP (intracranial pressure) monitor which gives staff a constant read out of the ICP. If the rise of the ICP is due to fluid buildup (blood or cerebral spinal fluid), the fluid buildup may evolve over time. Or staff will determine a craniotomy is needed. The surgeon opens the skull (creating a flap) and performs necessary remedial surgery which may include removal or evacuation of the bleed, clot or offending material.
Brain swelling or edema can have devastating consequences for a person who suffered a brain injury. When recognized, emergency room physicians can introduce medications (e.g., steroids) to reduce swelling when surgical intervention is not yet indicated. Again, close monitoring of patient's mental condition and intracranial pressure is necessary to, hopefully, avoid the patient having a secondary insult to their brain following the original brain injury (concussion).
Individuals who sustain a traumatic brain injury can have a seizure (even though they previously never experienced one). Brain seizures may be evaluated through EEG's, which record a snapshot of brain activity. Referral to a neurologist who treats patients with seizures may be warranted for follow up and if deemed necessary, medications. Seizures can have significant impact on a person's daily life activities, education and employment. Full evaluation and treatment with a specialist may be prescribed.
Prompt evaluation of a potential brain injury can be life saving.
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