Supportive Care Concerns

By January 19, 2019 April 11th, 2019 No Comments

The medical staff providing supportive care for the unconscious individual is highly trained and understands how to care for traumatic brain injury (TBI) patients.

TBI patients are monitored with equipment for breathing, heart rhythm, blood pressure, pulse and intracranial pressure.

Sometimes the unconscious individual cannot breathe without assistance.  The airway is maintained and breathing occurs though special tubes that help maintain oxygen in the blood.  It may be necessary to suction, as to remove thick secretions and keep the air tube clean.

The tube may be located in the mouth or in the neck.  If it is in the neck, it is called a tracheostomy tube.  Either tube will need to be cleaned daily.  A pulse oximeter measures the amount of oxygen the patient is receiving through a device that resembles a finger splint.

After head trauma, seizures can occur.  Dilantin is the usual medication administered through the IV to prevent seizures. A tetanus shot also may be given.

Fluid is administered through the IV for nutrition and liquid. The unconscious person cannot eat or drink safely. The need for nutritional support using parenteral (IV) or enteral solutions (a tube placed in the stomach) is determined by a registered dietician and the doctor.

A urinary catheter is put in the bladder for urine collection. The individual is not aware of the need to use the bathroom.  The catheter attaches to a bag hanging from the side of the bed.

It is important to maintain the unconscious patient’s blood pressure through IV fluid and medication. Ideally, the blood pressure range should be close to 90/70.

The patient is turned and positioned in bed to prevent bedsores because most unconscious people cannot move independently.

The unconscious person may have a compression device wrapped around the legs that resembles a plastic tub mat. This device prevents blood clots.  Daily injections are also given to prevent blood clots.

Intracranial pressure (the pressure in the brain) is controlled through the use of monitoring devices.  Doctors place a small bolt in the patient’s skull to measure intracranial pressure (ICP).   A catheter is attached to the bolt in the brain which connects to a gauge that registers the amount of pressure in the skull.  This procedure is most commonly performed on patients with moderate or severe brain injury.

The trauma care staff may try to keep the pressure down by:

  • Controlling body temperature (keeping the temperature low to normal)
  • Elevating the head of the bed
  • Using controlled narcotic sedation to cause paralysis, keeping the person still and comfortable
  • Ensuring proper breathing
  • Administering medication including Mannitol
  • Hypertensive therapies
  • Diagnostic Tests

The medical staff may conduct a number of diagnostic tests to determine what is occurring internally after the accident or illness.  X-rays, CT scans and MRIs of brain are pictures of the inside of the head. The picture will show if there is bleeding and/or swelling, skull fractures and where the damage has been done.

Often, cervical spine and other spinal films may be completed. When someone is involved in trauma, the neck and back may also be injured.

An EEG is a test that shows the presence of brain waves, their intensity and frequency. It is also used to determine if the patient is having seizures.