Brittany’s parents have just been driven to the hospital by the police officer, because they are hysterical and unable to drive themselves. After being in the ED for an hour, Brittany is still drifting in and out of consciousness. The ED physician determines, using her Glasgow Coma Scale result of nine, her CT scans and X-rays, that Brittany has suffered moderate traumatic brain injury (MTBI). In addition to her brain injury, she has also suffered an injury to her sixth thoracic vertebrae (T6); which has caused a loss of mobility in her legs. The good news is that Brittany does not have a complete break and she is able to move her upper body; however it is still unknown if she will regain full mobility of her legs again. Since Hitech Medical Center is a Level 1 Trauma Center, Brittany is fortunate to be treated here. A Level 1 Trauma Center increases a seriously injured patient’s chance of survival by an estimated 20–25 percent.
The ED physician explains to her parents that Brittany needs life saving brain surgery. Prior to surgery, Brittany’s head will be shaved. The neurosurgeon will cut through Brittany’s scalp to remove a section of skull so that he can access her brain. This will allow the surgeon to perform one or all of the following:
Remove hematomas. Many people who have traumatic brain injuries are taken straight from the ED to the operating room (OR) for removal of large deposits of clotted blood trapped between the skull and the brain. This reduces the pressure inside the skull and helps prevent additional brain damage.
Repair skull fractures. Many skull fractures heal on their own, but repairs are needed if any portion of the skull is pressing into the brain.
Open a window in the skull. If the pressure inside the skull cannot be controlled by any other means, one surgical option is to create an opening in the skull and leave it open until swelling subsides, which usually happens within a few days.
Internet Research: Define traumatic brain injury.
Review the Video: Watch the short video below on the contrecoup movement of Brittany’s brain during the accident. What potential problem can you see?
Internet Research: Brittany may face other complications from her brain injury, besides losing consciousness. Provide a brief explanation of each of the areas listed below:
Blood vessel damage:
Behavioral and Emotional changes:
Degenerative brain disease:
Glasgow Coma Scale: A grading system for determining neurological function and mental status (alertness) after a traumatic head injury. Eye opening, verbal response and motor response are graded. The lowest score is 3 and a normal score is 15.
(“What Is the Glasgow Coma Scale?” Brainline.org. Merriam-Webster, n.d. Web. 05 June 2014.)
Level 1 Trauma Center: A hospital that provides the highest level of surgical care to trauma patients and has a full range of specialists and equipment available 24 hours a day.
(“Levels of Definitive Trauma Care Facilities.” www.barnesjewish.org. N.p., n.d. Web. 05 June 2014.)
Neurosurgeon: A physician who specializes in surgery on the brain and other parts of the nervous system.
(“Neurosurgeon.” Medterms. MedicineNet, n.d. Web. 05 June 2014.)
Hematoma: A collection of blood outside the blood vessels, generally the result of internal bleeding. Commonly called a bruise.
(“Hematoma.” Medterms. MedicineNet, n.d. Web. 06 June 2014.)
Contrecoup: [kon″truh-koo´] (Fr.) Denoting an injury, as to the brain, occurring at a site opposite to the point of impact.
(“Contrecoup.” Merriam-Webster. Merriam-Webster, n.d. Web. 06 June 2014.)