Arrival at Hospital & Early Treatment

The Accident and Emergency (A&E) department

After a brain injury many people will be taken to the nearest A&E department. However some may not and will be admitted straight to a ward. An initial assessment will be carried out and the doctor will prioritise the treatment needed.

Medical staff will carry out various tests to check for complications such as blood clots or bleeding in the brain. These tests may include a CT or MRI scan of the head.

The process can take some time and may be quite confusing for relatives. It is also a time of great anxiety. Although you may want to remain with your relative it may not always be possible. Some people find it too distressing and prefer not to be there and most A&E departments will have a ‘quiet room’ for relatives to be on their own.

Transfer to wards or other hospitals.

Following assessment in the A&E department the doctors will decide on the most appropriate ward or hospital for treatment. Depending on the severity of the brain injury, your relative may be transferred to another hospital. However, it may be decided not to transfer them due to a variety of reasons, such as if they also have other injuries which require urgent attention on a different ward, e.g., Orthopaedic Surgery or General Surgery.

Doctors will continue monitoring the patient and carry out further tests to obtain a clearer picture of the brain injury, its potential effects and what treatment might be required.

The Staff Team could consist of

• Neurosurgeon

• Intensive Care doctors

• Rehabilitation doctors

• Ward Nurses

• Specialist Nurse

• Physiotherapist

• Occupational Therapist

• Neuropsychologist

• Speech and Language Therapist

• Social Worker

• Dietician

At this stage, your relative may be in a somewhat confused, drowsy or agitated state and unable to communicate properly. Due to the nature of brain injuries no two people are affected in the same way. The medical and nursing teams will monitor for any changes in behaviour or level of consciousness.

Some changes may suggest signs of recovery, some that there is a worsening or deterioration in the person’s condition. This could be due to swelling of the brain (oedema) or bleeding in the brain (haematoma) and if these complications occur, your relative may require neurosurgery. The staff should keep you updated on any such significant developments.

Neurosurgery

This may be done at a hospital out of the County of Lincolnshire. Sometimes, it becomes apparent that an operation will be needed. This is often to remove a blood clot, drain bleeding or relieve swelling in the brain which would cause further damage. A procedure called a craniotomy is often performed, in which a flap of bone is removed and then replaced. Sometimes the bone flap is removed and not replaced and this procedure is called a Craniectomy.

Surgical Critical Care Unit

After any neurosurgery has been carried out your relative may be transferred to the Surgical Critical Care Unit, which includes the Intensive Care Unit (ICU). Due to the number of machines, drips and tubes this can be quite frightening for relatives, however, being in ICU means that your relative will be looked after 24 hours a day by highly trained staff, using specialist equipment to monitor and treat them.

Whilst in the ICU the priorities will be to reduce the risk of further damage to the brain. Your relative may be sedated or unconscious and may be attached to various machines to assist with breathing (ventilator), monitor pressure within the skull (intracranial pressure monitor), keep them hydrated and nourished (intravenous infusion) and drain away urine (using a catheter).