Traumatic Brain Injury (TBI) (HB)

A traumatic brain injury is any trauma to the head that results in a change to mental status. If the patient was knocked out or “saw stars,” had their “bell rung,” etc., they have a TBI. Full stop. There is no such thing as a “possible” TBI. It either is, or it isn’t.

A traumatic brain injury is the same thing as a concussion. Boxers, football players, and people in impact sports experience these not infrequently.

The change in mental status could be full unconsciousness for several minutes or as subtle as confusion and disorientation. Patients may experience amnesia.

Treatment of a TBI is mainly supportive care. They do not necessarily need to go to a hospital, but we need to monitor them for at least twenty-four hours (remember peak swelling occurs in 24 hours).

We become more concerned with a TBI, and consider it SERIOUS, when the patient has persistent disorientation, cannot retain new memories, has a history of previous TBI (especially in the last six months), has a fracture of the skull, or the mechanism was with something that was either fast-moving or large (or both). Also, any signs of increased intracranial pressure are considered SERIOUS.

There is an old myth that you cannot let a person with a TBI go to sleep. This myth is absolutely false. They can and should be allowed to sleep. Patients with severe TBIs are frequently induced into a coma in the hospital. The caveat is that there needs to be someone awake with them the entire time—YOU don’t get to sleep. The reason is that if they start having signs of increased intracranial pressure, or changes to mental status, they may not be able to manage their airway. Since vomiting is a risk, we need to make sure the patient does not aspirate anything they may throw up. The reality is that if they start having increased intracranial pressure, they will more than likely have a severe headache and will not be able to sleep anyway.

DO NOT give pain medications to a patient with TBI. No aspirin. No Ibuprofen. We do not want to mask symptoms of acute pain here, and we do not want to increase the potential for bleeding.

A TBI may, or may not, result in increasing intracranial pressure (ICP), which we will discuss next. We will always anticipate increasing ICP with a TBI. The more severe the mechanism, the more likely the patient will have swelling from the damaged tissue.