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Traumatic Brain Injury at a Glance
Traumatic Brain Injury (TBI) is a form acquired brain injury, occurs when a sudden trauma causes damage to the brain. The damage can be focal - confined to one area of the brain - or diffuse - involving more than one area of the brain.
TBI can result from a closed head injury or a penetrating head injury. A closed injury occurs when the head suddenly and violently hits an object but the object does not break through the skull. A penetrating injury occurs when an object pierces the skull and enters brain tissue.
Facts about Brain Injury
TBI is a major public health concern, the incidence of traumatic brain injury increases nowadays, mostly related to transportation accidents involving automobiles, motorcycles, pedestrians, etc. TBI has been replacing heart attack for leading cause of death for young adults, especially among male adolescents and young adults ages 15 to 24. The probable explanation about this condition is the young adults tend to drive furiously, ignore the safety for themself and others.
While for the elderly population, TBI also can be found both sexes 75 years and older, most of the case related to falls.
The cause of the TBI plays a role in determining the patient's outcome. For example, approximately 91 percent of firearm TBIs (two-thirds of which may be suicidal in intent) result in death, while only 11 percent of TBIs from falls result in death.
Other statistics dramatically tell the head injury in the United States. Each year:
· approximately 1.4 million people experience a TBI,
· approximately 50,000 people die from head injury,
· approximately 1 million head-injured people are treated in hospital emergency rooms, and
· approximately 230,000 people are hospitalized for TBI and survive.
Prevention
TBI is a form neurological disorders that devastating, deathliest but can be prevented. Based on the statistics, TBI mostly related to transportation accident, thus certain precaution such as wearing a helmet when riding a bicycle or motorcycle and wearing a seatbelt when driving or riding in a car, greatly reduce the risk of TBI.
Not only using head-protector, but also our attitude in driving or riding vehicle is important, we should think about safety whether for ourselves and others.
General Trauma
Most TBI patients also have injuries to other parts of the body in addition to the head and brain. These traumatized patients require immediate and specialized care, that give comprehensive treatment and manage the recovery from the TBI.
Other medical complications that may accompany a TBI include pulmonary (lung) dysfunction; cardiovascular (heart) dysfunction from blunt chest trauma; gastrointestinal dysfunction; fluid and hormonal imbalances; and other isolated complications, such as fractures, nerve injuries, deep vein thrombosis , excessive blood clotting, and infections.
Those comorbidities have to be managed simultantly and comprehensively, since it will determine the patient conditions later.
Signs and Symptoms of TBI
Symptoms of a TBI can be mild, moderate, or severe, depending on the extent of the damage to the brain. Some symptoms are evident immediately, while others do not surface until several days or weeks after the injury.
A mild TBI person may remain conscious or may experience a loss of consciousness for a few seconds or minutes. The person may also feel dazed or not like himself for several days or weeks after the initial injury. Other symptoms of mild TBI include headache, confusion, lightheadedness, dizziness, blurred vision or tired eyes, ringing in the ears, bad taste in the mouth, fatigue or lethargy, a change in sleep patterns, behavioral or mood changes, and trouble with memory, concentration, attention, or thinking.
While a person with a moderate or severe TBI may show these same symptoms, but may also have a headache that gets worse or does not go away, repeated vomiting or nausea, convulsions or seizures, inability to awaken from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness or numbness in the extremities, loss of coordination, and/or increased confusion, restlessness, or agitation.
Small children with moderate to severe TBI may show some of these signs as well as signs specific to young children, such as persistent crying, inability to be consoled, and/or refusal to nurse or eat. Anyone with signs of moderate or severe TBI should receive medical attention as soon as possible.
Management of TBI patient
Traumatic Brain Injury usually result from an accident, most of the cases are emergency. Thus proper management of TBI patients should emphasized and be done from the scene of the accident, transportation of the patients and at the hospital.
Usually the settings are very dramatical, since the accident may so destructive and there are multi-trauma to the patient body. When facing with this situation, the emergency medical services must be activated such as calling 911 in US.
Because little can be done to reverse the initial brain damage caused by trauma, medical personnel try to stabilize the patient and focus on preventing secondary brain injury. Primary concerns include insuring proper oxygen supply to the brain and the rest of the body, maintaining adequate blood flow, and controlling blood pressure.
Emergency medical personnel may have to open the patient's airway or perform other procedures to make sure the patient is breathing. They may also perform CPR to help the heart pump blood to the body, and they may treat other injuries to control or stop bleeding. Because many head-injured patients may also have spinal cord injuries, medical professionals take great care in moving and transporting the patient. Ideally, the patient is placed on a back-board and in a neck restraint. These devices immobilize the patient and prevent further injury to the head and spinal cord. Medical professionals take great care in moving and transporting head-injured patients. Often back-boards and neck restraints are used to immobilize patients and prevent further injury.
As soon as TBI's patient stabilized, the next steps are assessing patient condition by measuring vital signs and reflexes and by performing a neurological examination. Paramedics or emergency medical personell will check the patient's temperature, blood pressure, pulse, breathing rate, and pupil size in response to light. They assess the patient's level of consciousness and neurological functioning using the Glasgow Coma Scale, a standardized, 15-point test that uses three measures - eye opening, best verbal response, and best motor response - to determine the severity of the patient's brain injury.
Imaging tests help in determining the diagnosis and prognosis of a TBI patient. Patients with mild to moderate injuries may receive skull and neck X-rays to check for bone fractures or spinal instability. The patient should remain immobilized in a neck and back restraint until medical personnel are certain that there is no risk of spinal cord injury.
For moderate to severe cases, the gold standard imaging test is a computed tomography (CT) scan. The CT scan creates a series of crosssectional X-ray images of the head and brain and can show bone fractures as well as the presence of hemorrhage, hematomas, contusions, brain tissue swelling, and tumors. Magnetic resonance imaging (MRI) may be used after the initial assessment and treatment of the TBI patient. MRI uses magnetic fields to detect subtle changes in brain tissue content and can show more detail than X-rays or CT. Unfortunately, MRI is not ideal for routine emergency imaging of TBI patients because it is time-consuming and is not available in all hospitals.
Approximately half of severely head-injured patients will need surgery to remove or repair hematomas or contusions. Patients may also need surgery to treat injuries in other parts of the body. These patients usually go to the intensive care unit after surgery.
Sometimes when the brain is injured swelling occurs and fluids accumulate within the brain space. It is normal for bodily injuries to cause swelling and disruptions in fluid balance. But when an injury occurs inside the skull-encased brain, there is no place for swollen tissues to expand and no adjoining tissues to absorb excess fluid. This increased pressure is called intracranialpressure (ICP) .
Medical personnel measure patients. ICP using a probe or catheter. The instrument is inserted through the skull to the subarachnoid level and is connected to a monitor that registers the patient's ICP. If a patient has high ICP, he or she may undergo a ventriculostomy , a procedure that drains cerebrospinal fluid (CSF) from the brain to bring the pressure down. Drugs that can be used to decrease ICP include mannitol or barbiturates, although the safety and effectiveness of the latter are unknown.
TBI can result from a closed head injury or a penetrating head injury. A closed injury occurs when the head suddenly and violently hits an object but the object does not break through the skull. A penetrating injury occurs when an object pierces the skull and enters brain tissue.
Facts about Brain Injury
TBI is a major public health concern, the incidence of traumatic brain injury increases nowadays, mostly related to transportation accidents involving automobiles, motorcycles, pedestrians, etc. TBI has been replacing heart attack for leading cause of death for young adults, especially among male adolescents and young adults ages 15 to 24. The probable explanation about this condition is the young adults tend to drive furiously, ignore the safety for themself and others.
While for the elderly population, TBI also can be found both sexes 75 years and older, most of the case related to falls.
The cause of the TBI plays a role in determining the patient's outcome. For example, approximately 91 percent of firearm TBIs (two-thirds of which may be suicidal in intent) result in death, while only 11 percent of TBIs from falls result in death.
Other statistics dramatically tell the head injury in the United States. Each year:
· approximately 1.4 million people experience a TBI,
· approximately 50,000 people die from head injury,
· approximately 1 million head-injured people are treated in hospital emergency rooms, and
· approximately 230,000 people are hospitalized for TBI and survive.
Traumatic Brain Injury
Prevention
TBI is a form neurological disorders that devastating, deathliest but can be prevented. Based on the statistics, TBI mostly related to transportation accident, thus certain precaution such as wearing a helmet when riding a bicycle or motorcycle and wearing a seatbelt when driving or riding in a car, greatly reduce the risk of TBI.
Not only using head-protector, but also our attitude in driving or riding vehicle is important, we should think about safety whether for ourselves and others.
General Trauma
Most TBI patients also have injuries to other parts of the body in addition to the head and brain. These traumatized patients require immediate and specialized care, that give comprehensive treatment and manage the recovery from the TBI.
Other medical complications that may accompany a TBI include pulmonary (lung) dysfunction; cardiovascular (heart) dysfunction from blunt chest trauma; gastrointestinal dysfunction; fluid and hormonal imbalances; and other isolated complications, such as fractures, nerve injuries, deep vein thrombosis , excessive blood clotting, and infections.
Those comorbidities have to be managed simultantly and comprehensively, since it will determine the patient conditions later.
Signs and Symptoms of TBI
Symptoms of a TBI can be mild, moderate, or severe, depending on the extent of the damage to the brain. Some symptoms are evident immediately, while others do not surface until several days or weeks after the injury.
A mild TBI person may remain conscious or may experience a loss of consciousness for a few seconds or minutes. The person may also feel dazed or not like himself for several days or weeks after the initial injury. Other symptoms of mild TBI include headache, confusion, lightheadedness, dizziness, blurred vision or tired eyes, ringing in the ears, bad taste in the mouth, fatigue or lethargy, a change in sleep patterns, behavioral or mood changes, and trouble with memory, concentration, attention, or thinking.
While a person with a moderate or severe TBI may show these same symptoms, but may also have a headache that gets worse or does not go away, repeated vomiting or nausea, convulsions or seizures, inability to awaken from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness or numbness in the extremities, loss of coordination, and/or increased confusion, restlessness, or agitation.
Small children with moderate to severe TBI may show some of these signs as well as signs specific to young children, such as persistent crying, inability to be consoled, and/or refusal to nurse or eat. Anyone with signs of moderate or severe TBI should receive medical attention as soon as possible.
Management of TBI patient
Traumatic Brain Injury usually result from an accident, most of the cases are emergency. Thus proper management of TBI patients should emphasized and be done from the scene of the accident, transportation of the patients and at the hospital.
Usually the settings are very dramatical, since the accident may so destructive and there are multi-trauma to the patient body. When facing with this situation, the emergency medical services must be activated such as calling 911 in US.
Because little can be done to reverse the initial brain damage caused by trauma, medical personnel try to stabilize the patient and focus on preventing secondary brain injury. Primary concerns include insuring proper oxygen supply to the brain and the rest of the body, maintaining adequate blood flow, and controlling blood pressure.
Emergency medical personnel may have to open the patient's airway or perform other procedures to make sure the patient is breathing. They may also perform CPR to help the heart pump blood to the body, and they may treat other injuries to control or stop bleeding. Because many head-injured patients may also have spinal cord injuries, medical professionals take great care in moving and transporting the patient. Ideally, the patient is placed on a back-board and in a neck restraint. These devices immobilize the patient and prevent further injury to the head and spinal cord. Medical professionals take great care in moving and transporting head-injured patients. Often back-boards and neck restraints are used to immobilize patients and prevent further injury.
As soon as TBI's patient stabilized, the next steps are assessing patient condition by measuring vital signs and reflexes and by performing a neurological examination. Paramedics or emergency medical personell will check the patient's temperature, blood pressure, pulse, breathing rate, and pupil size in response to light. They assess the patient's level of consciousness and neurological functioning using the Glasgow Coma Scale, a standardized, 15-point test that uses three measures - eye opening, best verbal response, and best motor response - to determine the severity of the patient's brain injury.
Imaging tests help in determining the diagnosis and prognosis of a TBI patient. Patients with mild to moderate injuries may receive skull and neck X-rays to check for bone fractures or spinal instability. The patient should remain immobilized in a neck and back restraint until medical personnel are certain that there is no risk of spinal cord injury.
For moderate to severe cases, the gold standard imaging test is a computed tomography (CT) scan. The CT scan creates a series of crosssectional X-ray images of the head and brain and can show bone fractures as well as the presence of hemorrhage, hematomas, contusions, brain tissue swelling, and tumors. Magnetic resonance imaging (MRI) may be used after the initial assessment and treatment of the TBI patient. MRI uses magnetic fields to detect subtle changes in brain tissue content and can show more detail than X-rays or CT. Unfortunately, MRI is not ideal for routine emergency imaging of TBI patients because it is time-consuming and is not available in all hospitals.
Approximately half of severely head-injured patients will need surgery to remove or repair hematomas or contusions. Patients may also need surgery to treat injuries in other parts of the body. These patients usually go to the intensive care unit after surgery.
Sometimes when the brain is injured swelling occurs and fluids accumulate within the brain space. It is normal for bodily injuries to cause swelling and disruptions in fluid balance. But when an injury occurs inside the skull-encased brain, there is no place for swollen tissues to expand and no adjoining tissues to absorb excess fluid. This increased pressure is called intracranialpressure (ICP) .
Medical personnel measure patients. ICP using a probe or catheter. The instrument is inserted through the skull to the subarachnoid level and is connected to a monitor that registers the patient's ICP. If a patient has high ICP, he or she may undergo a ventriculostomy , a procedure that drains cerebrospinal fluid (CSF) from the brain to bring the pressure down. Drugs that can be used to decrease ICP include mannitol or barbiturates, although the safety and effectiveness of the latter are unknown.
