Brain Injury Services

The Accident and Emergency (A&E) Department

After a brain injury many people will be taken to the nearest A&E department. However some may not and will be admitted straight to a ward. An initial assessment will be carried out and the doctor will prioritise the treatment needed.

Medical staff will carry out various tests to check for complications such as blood clots or bleeding in the brain. These tests may include a CT or MRI scan of the head.

The process can take some time and may be quite confusing to relatives. It is also a time of great anxiety. Although you may want to remain with your relative it may not always be possible. Some people find it too distressing and prefer not to be there and most A&E departments will have a ‘quiet room’ for relatives to be on their own.

Transfer to wards

Following assessment in the A&E department the doctors will decide on the most appropriate ward for treatment. Depending on the severity of the brain injury, your relative may be transferred to the Neurology Department. However, there may be an initial referral to a different ward, e.g.  Orthopaedic Surgery or General Surgery should they have other injuries which require urgent attention.

Neurology Department

The Neurology Department is made up of specialist wards where doctors can continue monitoring the patient and carrying out further tests to obtain a clearer picture of the brain injury, its potential effects and what treatment might be required. The professionals involved may be some of the following:

· Neurosurgeon    

· Neuropsychologist

· Intensive Care Doctors 

· Ward Nurses                  

· Speech and Language Therapist

· Occupational Therapist 

· Dietician

· Specialist Nurses  

· Social Worker 

· Physiotherapist

At this stage, your relative may be somewhat confused, drowsy or in an agitated state and unable to communicate properly. Due to the  nature of brain injuries no two people are affected in the same way. The  medical and nursing teams will monitor any changes in behaviour or level of consciousness.

Some changes may suggest signs of recovery, whereas others may indicate that there is a worsening or deterioration in the person’s condition. This could be due to swelling of the brain (Oedema) or bleeding in the brain (haematoma) and if these complications occur, your relative may require neurosurgery. The staff should keep you updated on any significant developments.

Neurosurgery

Sometimes, it becomes apparent that an operation will be needed. This is often to remove a blood clot, drain bleeding or relieve swelling in the brain which would cause further damage. This procedure  is called a craniotomy.

Surgical Critical Care Unit

After any neurosurgery has been carried out your relative may be transferred to the Surgical Critical Care Unit, which includes the Intensive Care Unit (ICU) and High Dependency Unit (HDU).

Due to the number of machines, drips and tubes this can be quite frightening for relatives, however, being in ICU / NHDU means that your relative will be looked after 24 hours a day by highly trained staff, using specialist equipment to monitor and treat them.

Whilst in ICU/NHDU the priorities will be to reduce risk of further damage to the brain. Your relative may be sedated or unconscious and may be attached to various machines to assist with breathing (ventilator), monitor pressure within the skull (intracranial pressure monitor), keep them hydrated and nourished (intravenous infusion) and drain away urine (using a catheter).

Early Stages

Unconsciousness / coma

Often a person with a brain injury will be unconscious at this stage and they may be referred to as being in a coma. Coma may last for any period of time from a few minutes to several weeks and it is not possible to predict how long it may continue.

If your relative is in a coma they may look as though they are asleep, or may seem very restless and agitated. Different people display different levels of responsiveness while in a coma and doctors may use the Glasgow Coma Scale (GCS) to assess the level of response. The GCS assesses the level of consciousness by measuring eye, verbal and motor responses to stimulation.

It can be very distressing to see your relative in a coma and you may feel frustrated and helpless. In time, there may be things you can do to help, but some activities can have an unhelpful effect on recovery. Remember to communicate as much as possible with the staff team and be guided by them.

After a period of unconsciousness a person may appear confused, agitated, or distressed and not be able to remember day-to-day events properly or recognise family or friends. They may be aggressive or hostile and may wander off, regardless of other injuries. They may also engage in behaviour of a sexual nature which can be embarrassing. This is known as  post-traumatic amnesia (PTA) and can be very distressing for  families and carers.

It may be helpful for you to understand that your relative is not in control of what they say or do while in PTA, so try not to take their behaviour personally or dwell on it too much. The length of PTA varies and can last from a few minutes or hours to a number of weeks or even months. The length of time spent in PTA and the length of the period of unconsciousness are regarded as indicators of the severity of injury after TBI. This can give an indication of the level of recovery that can be expected, but all brain injuries are different so there are no definitive rules on this.