The acute care phase of a brain injury often includes emergency care in hospital. It can be one of the most overwhelming times for families.
Since brain injuries often happen through an accident, it is not unusual for a person to have other injuries. A series of tests are performed to diagnose the injuries and a team of medical staff work to stabilise the patient’s condition.
Some of the outcomes of a brain injury, which are treated in acute care, include:
- Brain swelling
- Spinal injuries
- Coma
- Post–traumatic amnesia (loss of memory)
Sometimes when the brain is injured, swelling occurs and it compresses the brain inside the skull. Swelling can create pressure on the brain which can lead to further brain damage. Treatments for brain swelling often involve medication, a catheter (thin tube) to drain increased fluid from the brain or surgery.
If there is suspected spinal injury, the patient may be placed in a hard collar to restrict their movements and help prevent further injury to the spine until any damage to the spine has been investigated. Hard collars are used as a precaution and do not mean that the patient definitely has a spinal injury.
Deep in the centre of the brain is an area that is responsible for keeping us aware of what is happening around and inside us. If this area of the brain is damaged, a coma follows. Coma is the loss of consciousness in which patients lose their ability to speak, open their eyes and respond. Mild brain injury can cause a coma that lasts for one to two minutes, but a severe brain injury can result in a coma that continues for days and, in some cases, even longer.
A person does not suddenly wake up from a coma. As the coma lightens, the person may begin to respond to someone’s voice or touch, but the process is slow. It can be an anxious time for family members, but great anticipation too.
At first, the patient may not recognise you or other people they knew before the coma. They may be confused about where they are, who they are and what has happened to them. When a person is regaining consciousness, they may not be able to remember recent events or even the things that happened to them. This is called Post Traumatic Amnesia (PTA). In the early stages of post-traumatic amnesia , a person may be fearful, aggressive, disoriented and restless. People experiencing PTA become easily agitated and are often unable to cope with a lot of noise, movement or activity. It is important to keep outside stimulation to a minimum, which may mean few visitors allowed and for short periods of time.
Intensive care unit
Each person in intensive care is allocated one nurse. Their condition will be monitored 24 hours a day. The aim of immediate treatment is to maintain breathing and to minimise brain swelling.
While in intensive care, a person may:
- Be unconscious
- Be conscious but unable to speak
- Be heavily sedated
- Wear eye pads to stop their eyes drying out
- Have tubes in their nose, mouth or throat to assist breathing
- Have a shaved head from surgery
- Perspire excessively
Initially, it can be a shock to see so much machinery attached to a person. It helps to understand what these machines do. Don’t be afraid to ask the nurses to explain their functions to you.
Family members can reassure a person in intensive care by simply talking with them and behaving in their presence as if they were conscious.
When a person’s medical condition has stabilised, they will be transferred from intensive care to a ward. This is a good time to bring in some of their belongings: for example photos, which can give staff an understanding of who the person was before the trauma and helps staff talk to them in a familiar and supportive way.
Your care team
It is important to become familiar with the different hospital departments, wards and key staff that are providing the treatment for your loved one.
Many professionals make up the health care team. Your family member may go to the neurosurgical ward which specialises in the care of people with brain and spinal cord injuries or disease. Staff who work here include nurses with expert training in brain and spinal injuries, neurophysiotherapists, occupational therapists, dieticians, speech therapists and social workers.
Caring for yourself
When a family member is in hospital, it is natural to put their needs before your own. It is important to remember that to make sure the person you are caring for gets the best outcomes, you also need to look after your own emotional and physical health.
Here are some ideas on how to cope with the traumatic experience of having a loved one sustain a brain injury:
- Understand everyone reacts differently to stress.
- Accept support from people around you. Ask a friend, family member or hospital social worker/patient liaison officer to help you in discussions with the health care team.
- Talking with other people about your feelings can help you process what has happened.
- Setting up a Facebook page for your family member and updating this about their condition can keep friends and family informed about patient’s progress and reduce pressure on you.
- Write down your questions for the medical staff.
- Ask for an interpreter at any meetings if English is your second language.