PCL Group :D: Treatment & Management of Brain Injury

Yo dawgs, just to let you know, most of my information was taken from the first link provided (see sources below). I have summarized very succintly the information, coz' if I didn't, it would have taken far more space. I don't believe any of you will click on the link, but I have, on my own discretion, taken what I believe is most important to post here. This is a disclaimer so just in case anything comes out in exam, don't come running to me... *insert a very nice smiley face here* Now, on with the show:

Process:

First aid
ICU
Acute Rehabilitation Unit
Sub-acute Rehabilitation Unit
Day Treatment (Day Rehab or Day Hospital)
Outpatient Therapy
Home Health Services
Community Re-entry
Independent Living Programs
Brain Injury Support Groups

First aid (Emergency care until help arrives)

Call for help (999)
ABC, CPR
ABC okay, but the person is unconscious: treat as if there is a spinal injury. Stabilize the head and neck by placing your hands on both sides of the person's head, keeping the head in line with the spine and preventing movement.
Stop any bleeding by firmly pressing a clean cloth on the wound. If you suspect a skull fracture, DO NOT apply direct pressure to the bleeding site, and DO NOT remove any debris from the wound. Cover the wound with sterile gauze dressing.
If the person is vomiting, roll the head, neck, and body as one unit to prevent choking.

ICU
Goals: stabilize the patient and prevent further injury

Adequate oxygen supply to the brain and the rest of the body
maintain blood flow to the brain
control blood pressure
stabilize the airway
assist in breathing or perform CPR if necessary
treat associated injuries

Specialized treatment team

Neurologist: Primary treating physician
Neurosurgeons: remove blood clots, haematomas (e.g. subdural), intracerebral haemorrhages, perform procedures to relieve increased pressure within the skull
Intensivists: physicians staffing the ICU
Respiratory therapists: to monitor respiratory functions
Specialized nurses & technicians: e.g. radiological technicians
Trauma specialists: treat associated injuries

Equipment in the ICU

A Ventilator (Also called a Respirator) is a machine that helps a person breathe (as patient may unable to breathe on his/her own) - provides Oxygen

A tube is placed through the person’s mouth to the trachea: Intubation

Intravenous lines (IVs): tubes placed in a person’s veins to deliver medications and fluids to the person’s body
Arterial lines: tubes placed in a person’s arteries to measure blood pressure
A Foley Catheter is used to collect and monitor a person’s urine output (patient may be unable to control bladder functions

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

A Nasogastric Tube (NG Tube) is used to deliver medication and nutrients directly to a person’s stomach (patient may be unable to swallow on his/her own)

A tube is placed through a person’s nose or mouth and ran through the swallowing passage (the esophagus), to the stomach

An ECG machine monitors a person’s heart.
A Pulse Oximeter is a 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.
An Intracranial Pressure (ICP) Monitor is a 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 (oedema: subsides within a few days/weeks, but a few minutes or hours of excessive ICP can cause permanent damage).
When the brain swells, the brain has no place to expand. This can cause an increase in intracranial pressure (the pressure within the skull).
If the brain swells and has no place to expand, this can cause brain tissues to compress, causing further injury (as blood is prevented from circulating adequately in the brain tissue, causing damage to brain cells)
ICP can be measured with an intraventricular probe or catheter inserted through the skull into the fluid-filled chambers (ventricles) within the brain. Placement of the ICP catheter is usually guided by CT scan.
If ICP is elevated, drugs that may decrease ICP (MOA: draw fluid out of the brain and into blood vessels, decrease brain’s metabolic requirements, increase blood flow to injured tissues) include mannitol and barbiturates. NO halothane (cerebrovascular dilator).
Surgery for elevated ICP:

If severe brain swelling, the elevated pressure can be relieved temporarily by surgically removing a portion of the skull to allow swollen tissues to bulge out, reducing the risk for pressure-induced damage.
A build up of fluid may also cause the ventricles in brain to experience blockage. A ventriculostomy may be needed. A shunt is inserted to drain the fluid build-up (hydrocephalus), causing the ventricles to shrink and restoring normal function to brain cells.

Acute Rehabilitation Unit
When persons are medically stable and have reached a point in recovery where they are able to participate in therapy, they may be transferred to an inpatient Acute Rehabilitation setting.

Goals: assist persons with brain injuries to achieve their highest level of independent life skills used in activities of daily living; detect complications early; prevent additional injury

Acute Rehab Team

A Psychiatrist: the leader for the rehabilitation treatment team; makes referrals to the various therapies and medical specialists as needed. The physiatrist works with the rehabilitation team, the person with a brain injury, and the family to develop the best possible treatment plan.

Physical Therapists evaluate and treat a person’s ability to move the body; improves physical function by addressing muscle strength, flexibility, endurance, balance, and coordination (walking, getting in and out of bed, on and off a toilet, or in and out of a bathtub)

Occupational Therapists use purposeful activities as a means of preventing, reducing, or overcoming physical and emotional challenges (feeding, swallowing, grooming, bathing, dressing etc)

Speech/Language Pathologists evaluate a person’s ability to express oneself (speech, written, or otherwise expressed) and comprehend what is seen or heard. Swallowing issues may also be addressed.

Rehabilitation Nurses attempt to maintain the person’s medical status, anticipate potential complications, and work on goals to restore a person's functioning.

Case Managers/Social Workers are responsible for assuring appropriate and cost-effective treatment and the facilitation of discharge planning.

Recreational Therapists provide activities to improve and enhance self-esteem, social skills, motor skills, coordination, endurance, cognitive skills, and leisure skills.

Neuropsychologists focus on thinking skills, behavior, and emotional processing.

Aquatic Therapists are occupational therapists, physical therapists, or recreational therapists with specialized training to provide therapy in a heated water pool.

Subacute Rehabilitation

Less intensive level of rehabilitation services, over a longer period of time
Skilled nursing facility or nursing home.

Day Treatment provides rehabilitation in a structured group setting during the day and allows the person with a brain injury to return home at night.

Outpatient Therapy

Following acute rehabilitation or sub-acute rehabilitation, a person with a brain injury may continue to receive outpatient therapies to meet continued goals.
Additionally, a person with a brain injury that was not severe enough to require inpatient hospitalization may attend outpatient therapies to address functional impairments.

Home Health Services
Some hospitals and rehabilitation companies provide rehabilitation therapies within the home for persons with brain injury.

Community re-entry programs generally focus on developing higher level motor, social, and cognitive skills in order to prepare the person with a brain injury to return to independent living and potentially to work. Persons who participate in the program typically live at home.

Independent Living programs provide housing for persons with brain injury, with the goal of regaining the ability to live as independently as possible.

Brain Injury Support Groups can help individuals with brain injury and their loved ones cope and increase their knowledge about brain injury issues. Support group members can provide valuable emotional support because of their experiences and understanding of the impact of brain injury. Brain injury support groups are also a good place to network and learn from others--what they have done in similar situations.

Medications (refer to handout for specific information)
Medications for persons with brain injury are carefully selected, prescribed, and monitored by the physician on an individual basis (overlapping all stages).

With brain injury, the cell’s ability to produce neurotransmitters is reduced either by interference with production, release or absorption. These chemical changes alter the brain’s ability to process information. Medications prescribed after a brain injury improves the brain’s natural ability to produce and utilize neurotransmitters. The medications act as a cast for the neuron to allow more normal activity during recovery. In situations where the neuron fails to recover its function, medications then are used as splints to allow the most normal neuron function possible.

Analgesics may be used for pain relief and pain management.
Anti-Anxiety Agents may lesson feelings of uncertainty, nervousness, and fear.
Anti-Coagulants may be used to prevent blood clots.
Anti-Convulsants may be used to prevent seizures.
Anti-Depressants may be used to treat symptoms of depression.
Anti-Psychotics may be used to target psychotic symptoms of combativeness, hostility, hallucinations, and sleep disorders.
Muscle Relaxants may be used to reduce muscle spasms or spasticity.
Sedative-Hypnotic Agents may be used to induce sleep or depress the central nervous system in areas of mental and physical response, awareness, sleep, and pain.
Stimulants may be used to increase levels of alertness and attention.