From the ER to ICU
The brain is the control center of your body. It controls and
coordinates all the bodies’ thoughts and functions. Examples
of these functions are: blood pressure, breathing, movement,
speaking and emotions. When the brain is injured the patient can
lose any of these functions. How this effects the patient depends
on what part of the brain is injured and its severity. When a
brain is injured it can bleed and swell up causing the brain to not
get enough blood flow. If the bleeding is not stopped and if the
swelling worsens, this puts pressure on the brain and the patient
can end up with severe brain damage. So a person with a suspected
brain injury will need immediate attention and taken to the closest
emergency department (ED).
A visit to the emergency department can be a terrifying experience
for the patient as well as the family. A patient who arrives in the
ED with a brain injury will need immediate care. The doctor will
want to know what part of their brain is injured and how bad it
is. They will want to start taking care of the patient’s injury right
away. Early treatment can prevent further injury. The doctors
and nurses will have many questions about the events causing the
injury and the injury itself. Answering a lot of questions can be
very frustrating especially when one is worried about their family,
friend or loved one. Examples of these questions may be: If the
patient wrecked on a bicycle, they will want to find out all of the
details they can. Was the patient wearing a helmet? How fast were
they going? Did they flip over the handlebars? If the patient was
in a motor vehicle crash, they will want to know if the patient was
wearing a seat belt. How fast the car was going? Were they thrown
from the car? Was it a frontal crash? Was it a side impact crash?
Details such as these can help the doctors predict certain injuries.
For example, if the patient wasn’t wearing a helmet and flipped
over the handlebars of the bicycle; in addition to their brain injury
they could also have internal abdominal injuries.
Patients with a brain injury often lose consciousness, or appear to
be in a deep sleep. Some will arrive confused and some will ask
the same questions over and over. If they arrive like this, the staff
will want to know the patient’s normal behavior before the injury.
They will want to know if the patient got knocked out and for how
long? They will want to know if the patient is on any medications
and the patient’s past medical history. Do they have a history of
seizures? Do they have blood pressure problems? Do they have
heart problems? Do they have a history of alcohol or substance
abuse? These types of questions can be embarrassing and difficult
to answer but the truth will allow the doctors and nurses to take
the best care of the patient. The staff is not there to judge. They
are there to help the patient and provide the most appropriate
treatment.
When the patient first arrives to the ED they will be taken to an
examination room. All families and friends will be asked to wait
in the waiting room. This gives the doctor time to examine the
patient. The patient will never be left alone and will be watched
very closely by the doctors and nurses. The staff will keep family
and friends informed about the patient’s condition.
The nurses will monitor the patient’s blood pressure, heart rate
and rhythm, temperature and how they are breathing. The patient
may have an IV started so that the nurses can give the patient
IV fluids and medications if needed. The patient’s neurological
status will be monitored frequently to determine the extent of the
patient’s brain injury and to watch for any changes. The doctors
and nurses use a scale, called the Glasgow Coma Scale (GCS)
to monitor the patient’s neurological status. The scale scores the
patient’s best eye, motor and verbal responses (see bottom of pg.
11). The patient may respond by moving and positioning their
arms and legs in a strange way. This movement is important in
evaluating the patient’s progress and whether further treatment is
needed. Monitoring this scale often will alert staff of any changes
in the patient’s condition. The changes could be good or bad. The
nurses and doctors will also shine a light in the patient’s eyes to
check their pupillary response. Changes in pupillary response can
tell the doctor of possible problems.
When a patient is diagnosed with a brain injury, a neurosurgeon
is asked to examine the patient. A neurosurgeon is a doctor that
specializes in brain and spinal cord injuries. The neurosurgeon
will determine the extent of the brain injury and the best plan of
care.
The doctors will order lots of tests. These tests include a blood
test, x-rays, and a computed tomography scan (CT or a CAT
scan) and/or magnetic resonance imaging (MRI) of the head.
These tests are similar to an x-ray but allow the doctors to
visualize more clearly internal structures of the head. The doctor
will be able to see if there are any skull fractures, bleeding and/
or swelling of the brain. Most CT scanners and MRI machines
are not located in the ED, so the patient will need to travel to
these areas. The nurses and other staff will go with the patient
to the test and continue to watch the patient closely. These test
results will tell the neurosurgeon how seriously the patient is
injured. They may need to go directly to the operating room.
If no operation is needed they will be treated in the ED until a
room is available in the Intensive Care Unit (ICU) or floor unit.
2020-2022 BIAK Resource Journal 9