TREATMENT

Just as no two people are exactly alike, no two brain injuries are exactly alike. For some, brain injury is the start of a lifelong disease process. Brain injury requires access to a full continuum of treatment and community-based supports provided by appropriately educated clinicians serving on an interdisciplinary treatment team.

The individual who sustains a brain injury and his or her family are the most important members of the treatment team. Their choices, goals, and backgrounds must always be taken into consideration in treatment planning.

The diagram above depicts brain injury treatment in an orderly progression from trauma care to community integration. Individuals who sustain brain injuries may enter, exit, and re-enter treatment at any point along the continuum. Treatment may be needed continuously or on an intermittent basis throughout the individual’s life.

As recovery progresses following brain injury, it is likely the individual will see a change in the level of care and in the treatment setting. Since individuals do not always progress in a linear fashion, they will not always advance through the continuum of care in strict order.

Treatment in a hospital following a brain injury can range from a quick neurological assessment to longer-term, inpatient care. The length of one’s stay in the hospital will vary depending on the severity and implications from the brain injury.

Emergency Department (Emergency Room/ER)

It is likely one will first visit the Emergency Department, or Emergency Room (ER), following a brain injury. Oftentimes the decisions in the ER must be made quickly and without explanation. The treatment team focuses on saving lives. Measures to protect the brain from further injury or damage will be taken.

Intensive Care Unit (ICU)

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 goal in ICU is typically medical stability, management, and prevention of medical crisis. Those receiving treatment in the ICU for their brain injury may be unconscious, in a coma, and/or medically unstable. Many tubes, wires, and pieces of medical equipment may be attached to the patient to provide life sustaining medical care. The time in ICU is oftentimes quite upsetting and emotional for caregivers, loved ones, and family members. It is important for family members and caregivers to remember to take care of themselves throughout this time, as well.

During the time spent in the ICU, you will likely hear the treatment team mention or use important medical equipment.

• Ventilator
  A Ventilator (also called a Respirator) is a machine that helps the person breathe. A person who has sustained 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 their breathing passage, the trachea (often referred to as “windpipe”). This procedure is called intubation. Intubation with the use of a ventilator allows a person to breathe and receive oxygen, which is necessary for life.
• Intravenous (IV) Line
  Intravenous lines (IVs) are tubes placed in a person’s veins to deliver medications and fluids to the person’s body.
• Arterial Line
  Arterial lines are tubes placed in a person’s arteries to measure their blood pressure. 
• Foley Catheter
  A Foley Catheter is used to collect and monitor a person’s urine output. 
• Nasogastric (NG) Tube
  A Nasogastric Tube (referred to as an “NG Tube”) is used to deliver medication and nutrients directly to a person’s stomach. 
• EKG/EEG Machines
  An EKG machine monitors the person’s heart, and an EEG machine is used to monitor function in the person’s brain. 
• Intracranial Pressure (ICP) Monitor
  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. 
• Pulse Oximeter
  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. 

Step-Down Unit (SDU)

Once medically stable, an individual may be moved to a room within the Step Down Unit (SDU). SDUs provide an intermediate level of care between the Intensive Care Units (ICUs) and the general medical-surgical wards. These units also may be referred to intermediate or transitional care units. Likely the individual will receive slightly more rehabilitation (perhaps an hour or so more per day) than they did in the ICU.