As recovery progresses following brain injury, it is likely the individual will see a change in their level of care and in their treatment setting.
Since individuals do not always progress in a linear fashion, they will not always advance through the continuum of care in strict order.
Treatment in a hospital following a brain injury can range from a quick neurological assessment to longer-term, inpatient care. The length of one's stay in the hospital will vary depending on the severity and implications from their brain injury.
Emergency Room (ER)
It is likely one will first visit the Emergency Department, or Emergency Room (ER), following a brain injury. Oftentimes the decisions in the ER
must be made quickly and without explanation. The treatment team assisting the person with injury will focus on saving their life. Measures
to protect the brain from further injury or damage will be taken.
Intensive Care Unit (ICU)
After receiving emergency medical treatment, persons with a moderate to severe brain injury may be admitted to a hospital’s Inpatient Intensive Care Unit (ICU). The goal in ICU is typically medical stability, management, and prevention of medical crisis. Those receiving treatment in the ICU for their brain injury may be unconscious, in a coma, and/or medically unstable. Many tubes, wires, and pieces of medical equipment may be attached to the patient to provide life sustaining medical care. The time in ICU is oftentimes quite upsetting and emotional for caregivers, loved ones, and family members. It is important for family members and caregivers to remember to take care of themselves throughout this time, as well.
During the time spent in the ICU, you will likely hear the treatment team mention, or utilize, important medical equipment.
- A Ventilator (also called a Respirator) is a machine that helps the person breathe.
- A person who has sustained a brain injury may be unable to breathe on his or her own. To use a ventilator, a tube is placed through the person’s mouth to their breathing passage, the trachea (often referred to as “windpipe”). This procedure is called intubation. Intubation with the use of a ventilator allows a person to breathe and receive oxygen, which is necessary for life.
- Intravenous lines (IVs) are tubes placed in a person’s veins to deliver medications and fluids to the person’s body.
- Arterial lines are tubes placed in a person’s arteries to measure their blood pressure.
- A Foley Catheter is used to collect and monitor a person’s urine output.
- A person who has sustained a brain injury may be unable to control bladder functions.
- A rubber tube is inserted into the person’s bladder. This allows urine to move from the bladder, through the tube, and to a container at the end of the tube.
- A Nasogastric Tube (referred to as an "NG Tube") is used to deliver medication and nutrients directly to a person’s stomach.
- A person who has sustained a brain injury may be unable to swallow, so the NG Tube is placed through a person’s nose or mouth and ran through their swallowing passage (the esophagus) to the stomach.
- An EKG machine monitors the person’s heart, and an EEG machine is used to monitor function in the person's brain.
- Wires with sticky ends are placed on the body and communicate the information back to the EKG/EEG machine.
- An Intracranial Pressure (ICP) Monitor is a device attached to a person’s head with a monitor that indicates the amount of pressure in the
- When the brain is injured it may swell, and when this occurs the brain has no place to expand. This can cause an increase in intracranial pressure (the pressure within the skull). If the brain swells and has no place to expand, this can cause brain tissues to compress, causing further injury.
- A Pulse Oximeter is a small, clamp-like device placed on a person’s finger, toe or earlobe. The Pulse oximeter measures the amount of oxygen in the blood stream.
Step-Down Unit (SDU)
Once medically stable, an individual may be moved to a room within the Step Down Unit (SDU). SDU's provide an intermediate level of care between the Intensive Care Units (ICUs) and the general medical-surgical wards. These units also may be referred to intermediate or transitional care units. Likely the individual will also receive more rehabilitation (perhaps an hour or so per day) than they did in the ICU.