Initial treatment of a Traumatic Brain Injury (TBI) begins upon arrival to a hospital. At the hospital, a team of medical professionals, generally led by the trauma surgeon, will meet the patient. The trauma surgeon, acting as the leader, will direct the team. The trauma staff will initiate resuscitation procedures, monitor the body’s vital functions, respond to potential life-threatening changes and coordinate care with other hospital personnel.
The patient may need surgery for injuries. In addition to the trauma surgeon, the surgical staff could include the neurosurgeon, a physician who performs brain and spinal cord surgery; an orthopedic surgeon, a physician who works with broken bones such as fractures of the arms and legs or the spinal column; or a general surgeon.
While the physicians are assessing the patient and the response to treatment, the trauma nurse is caring for the patient: providing resuscitation, stabilization and supportive care. The nurses have the responsibility to coordinate and provide communication within the hospital and with the family.
Once stabilized, the patient will be transferred to a specialized trauma care unit. Care will be provided by the critical care nursing staff. The nursing staff’s responsibility is to assess, monitor and interpret vital physiologic or body functions, notify the physician of changes, repeat assessments at regular intervals and provide information for the family. The patient will be monitored for signs of infection and pain.
Other key staff also will play a role on the specialized trauma care unit. The respiratory therapist will help with the initial resuscitation efforts, will provide oxygen therapy, will configure the ventilator settings and will assure proper equipment functioning. In addition, the respiratory therapist will monitor the patient’s breathing: looking at blood gas results and listening to the lungs.
In most trauma centers, a psychologist familiar with acute trauma will be part of the team. Using crisis intervention techniques, the psychologist will assist the patient and family in decision-making during a crisis. The psychologist will provide counseling and education about the injury, as well as assess the cognition of the patient.
A trauma social worker will also work with the family after the injury. Like the psychologist, the social worker will prepare the family emotionally and physically to face the ill or disabled patient. The trauma social worker will assist the family in making plans for the duration of recovery, especially if the recovery progresses slowly. The trauma social worker will encourage the family to consider role and responsibility changes while the patient is ill, including changes in finances and family support. The trauma social worker will also assist the family in discharge planning.
Most patients proceed to a rehabilitation facility.