This blog is taken from our guide ‘Important information after a family member has sustained a Traumatic Brain Injury’. Download the full guide here >
When a family member has suffered a Traumatic Brain Injury, they will likely require urgent medical attention. Depending on the severity of the injury, your family member could be referred to a number of different medical facilities for testing, treatment and brain injury care.
In this blog, we’ll look at the various types of hospital treatment after a person suffers from a Traumatic Brain Injury, and explain what to expect for your family member.
The Emergency Department
After a TBI, the injured person will usually be taken to their nearest accident and emergency department or specialist acute TBI centre for treatment, testing and monitoring. During the initial assessment, the doctor will carry out investigations that will determine what injuries the person has sustained, and assess which need the most urgent treatment.
There are a few different tests that medical staff can use to help their diagnosis:
- X-rays: X-rays are a quick and effective way of checking for bone fractures and breaks. Doctors may use this test to assess additional injuries a person may have sustained.
- CT scans: CT (Computerised Tomography) uses a combination of multiple x-rays taken from different angles to create a computerised three-dimensional image. CT scans are used by doctors to look for bruising, swelling or blood clots, allowing them to understand what is happening in the brain, and what treatment might be needed.
- MRI scans: MRI (Magnetic Resonance Imaging) uses magnetic fields to create images of organs inside the body. This test differs from the previous two, as it doesn’t rely on x-rays, and may help provide different information to doctors.
Neurosurgical wards and neurosurgery
If the medical team decide on more specialist assessment, the injured person may be transferred to a neurosurgical ward. On the ward, they will usually be reviewed by a neurosurgeon who will assess any scans they’ve had already, and arrange additional investigations.
If the scans show bleeding and damage to the brain, surgery might be needed to remove any blood clots and repair damaged blood vessels. The medical team will discuss this with you in more detail.
In order to operate, surgeons will need to remove part of the skull. Sometimes, the bone will be left out post-surgery and be replaced at a later date. The neurosurgeon will decide if this is necessary during surgery. Neurosurgery is a complex and lengthy process that requires a general anaesthetic, so it can sometimes take some time for a person to regain consciousness after the operation.
Intensive care unit
After neurosurgery, your family member will usually be taken to either an intensive care unit (ICU) or high dependency unit (HDU). These units provide specialist high-level care 24 hours a day. There is usually one nursing staff assigned to each person on these wards. During this stage of recovery, the medical team will closely monitor your loved one and their condition.
Often, people in ICU will be given a sedative medication, so your family member may not be awake when you visit them. This is normal practice and will help them to recover from their injuries and prevent any further injuries or swelling.
If you have any questions about what is happening, the medical team will be able to help you. It’s a good idea to write down any questions you think of so that you remember to ask them when you meet with the treating consultants.
Comas and the Glasgow Coma Scale
Most people will lose consciousness after a brain injury, but if a person shows no signs of awareness and can’t be woken up, they’ll be described as being in a coma.
There are different levels of comas, each with varying degrees of awareness. This ranges from deep, where the person shows no response to a stimulus (such as pain), to more shallow, where the person will have some reaction (such as moving or opening their eyes).
Doctors use a metric known as the Glasgow Coma Scale (GCS) to assess a person’s level of consciousness. The scores vary from 3-15. If somebody is assessed at 15, this means they are coherent, can hold a conversation and follow instructions. The higher a person scores, the more conscious and aware they are.
The GCS scores the injury over three areas and adds them together to assess how severe the injury is. The three categories are:
- Eye opening: A person may open their eyes spontaneously, as a response to sound or pressure, or not at all. A score of one means no eye opening, with four indicating spontaneous eye opening.
- Verbal response: This measures whether a person is confused, knows where they are, and can use words or sounds. Scoring one means there is no response, while a five is given when a person is conscious and holding a conversation.
- Motor response: The final category measures a person’s reflexes, and whether they can follow instructions. A score of one means there is no response, while a six indicates they can follow a command.
Severity of Injury
14 – 15
9 – 13
3 – 8
Having a family member in a coma is a difficult and emotional time, and it’s completely normal to find this experience distressing or overwhelming. The NHS suggests that some injured people feel enormous reassurance from the presence of their family and friends, and visiting a family member can be extremely helpful for both the injured person and yourself.
It’s common to feel emotional while visiting your family member, or not knowing what to say. Research suggests that stimulating the senses - touch, hearing, vision and smell - can be extremely beneficial to a person’s recovery, so just being with them will help.
When you do visit your family member, try to stimulate their different senses. Always check with the medical team beforehand and gain guidance on what is appropriate for your family member. Here are a few tips that might help when you visit your family member:
- When you arrive, say out loud who you are.
- Talk to them as you normally would - you can chat about your day, what you’ve been doing, or what’s happening in the news.
- Even if you can’t think of anything to say, holding your family member’s hand or stroking their skin can be comforting for them.
- Play their favourite music through headphones.
- Stimulate their sense of smell through flowers, perfumes, or other fragrances.
Waking up from a coma isn’t usually a sudden thing. Instead people usually come to gradually, meaning they are often confused and disoriented to begin with. Once a person is conscious, the medical team can then assess the extent of the brain injury, and start to think about any long-term rehabilitation and treatment they might need.
How long a person is in a coma doesn’t indicate how they will recover once they come to. Every brain injury is unique, and each person's recovery is completely different.
When your family member no longer requires high levels of brain injury care and monitoring, they may be moved to a ward environment. However, they may still have complex care needs at this stage and still require assistance with many tasks.
At this stage, you may feel like you want to be more involved in your family member’s care. Speak with nursing staff to see if there are any tasks you can help your family member with under their supervision.
For more information on what to do after a family member has suffered a Traumatic Brain Injury, download our guide for helpful advice on symptoms, rehabilitation and care. <Download the guide>