Complex and Minor cases of Traumatic Brain Injury

Some years ago, I had a close friend who had a car accident where she hit her head during the course of the accident, she was rushed to the hospital, and she was treated appropriately, but about a month after the accident when she had fully recovered, she was at work when she slumped all of a sudden, we had to rush her to the hospital and the first question the nurse asked us was, if she had ever had any head injury prior to the time of the incident? This means there could be possible happening's after the healing process of a head injury, I thought to myself, as at the moment however, I was more bothered about my friend's health, so we rushed her in for treatments, we were told it was not such a serious thing after all, we just got medications and for the longest time, I don't think she has had any serious attack like that again, although the nurse told us that the chances of having a recurring fainting season is unavoidable.

Any serious blow or hit on the head always comes with different serious crises, I am grateful that my friend's case was not a serious one, but there are people who have had major lifetime crises as a result of a previous blow or hit to the head. Let's take a ride as we enjoy the details of traumatic brain injury.
Head injuries may cause bleeding either in the brain tissue or in the layers that surround the brain.

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Traumatic brain injury (TBI), is a sudden damage done to the brain, the damage is usually caused by a jolt or a blow to the head. Some of the common cases of TBI are caused by; falls, motorcycle crash, assaults, sport injuries. The damage caused to the brain could be mild or extremely serious, causing serious brain damage. The treatment for the condition created, depends greatly on the severity of the damage caused.
Traumatic brain injury are categorized into two; we have the primary injury as well as secondary injury.

Head injury could either be a closed or an open one. A closed head injury is when there is a hard blow to the head, but the hard hit does not affect the skull. An open or penetrating injury, on the other hand, means you were hit with an object that broke the skull and penetrated into the brain, this case is often associated with a strong force, properly going at a high speed when the accident happened or a gun shot the head as well.

Primary brain injury: This is the injury that is applicable at the immediate point of impact, the primary injury could involve a specific lobe of the brain or could involve the entire brain. There are moments when the skull may become fractured as well, but this is in a very rare condition, through the impact caused by the accident, the brain crashes back and forth inside the skull, therefore causing cases of bleeding, bruising and even tearing of the nerve fibers.

After the accident, the individual involved in the accident may begin to experience confusion and inability to remember what happened, the symptom is usually accompanied by a blurry vision, dizziness and lose of consciousness.

Secondary Injury:In these cases, the patient may appear to be physically alright after the incident, but as time goes on, conditions gradually begins to decline. With the experienced initial impact, what follows next is that, the brain begins to undergo delayed trauma, where it begins to swell, and it pushes itself against the skull, therefore limiting the flow of oxygen rich blood.

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The classification of Traumatic brain injuries are specifically dependent on the mechanism and the severity of the injury.

• Mild head injury: In this case, the individual with the head injury is awake, fully eyed opened, but there could be experienced symptoms of disorientation, headache, memory loss, confusion and even a brief loss of consciousness.

• Moderate head injury: In this case, the patient is lethargic, the eyes are opened based on stimulation, there is also loss of consciousness which could last for a minimum of 20 minutes or extend to 6 hours. Some cases of brain swelling associated with this classification comes with brain swelling, bleeding causing sleepiness but still arousable.

• Severe head injury: In this case, the patient is unconscious, the eyes are not opened for the duration even with stimulation, there is a loss of consciousness usually lasting for more than 6 long hours.

Types of traumatic brain injury.

Concussion: This is a mild injury to the head, it can create a slight or brief moment of lost conciousness, it does not cause any permanent brain damage.Concussion, is the most common type of traumatic brain injury that exists, it includes scalp wounds and skull fractures.

Contusion: This is a bruise to a specific side of the brain, often caused by an impact to the head. It is classified as coup injuries or contrecoup injuries. In this case, the brain is injured right under the point of impact, in the case of contrecoup however, the injury is felt at the side opposite to the point of impact.

Diffuse axonal injury: This is a case of shearing and streching of the nerve cell usually at the cellular level, this occurs when there is a quick brain movement often back and forth inside the skull, this movement gives room for the tearing and damaging of the nerve axons. Note that, axons are responsible for the connection of one nerve cell to another throughout the brain. When there is a case of widespread axonal injury, the normal transmission of information in the brain gets disrupts, this could lead to a substantial change in a person's wakefulness.

Traumatic Subarrachnoid Hemorrhage (tSAH): This involves bleeding into the space surrounding the brain. Usually, the space is normally filled with cerebrospinal fluid (CSF), it acts as a floating cushion serving as a protective cover to the brain. Traumatic SAH happens when small arteries gets torn during the process of initial injury, this spreads blood over the the surface of the brain, creating widespread effects.

Hematoma: This is a form of blood clot that forms after there is rapturing of the blood vessels. The blood that escapes theough the normal bloodstream begins to get thick and clot. It is important to bear in mind that, clotting is the body's natural way to stop bleeding. The case of hematoma could be a small one, it could also grow depending significantly on the location of the clot.

I mentioned earlier that not all cases of traumatic brain injury are immediately noticeable, others take time before they become noticeable. Some signs of traumatic brain injury include;

• Confusion.
• Nausea and vomiting.
• Slurred speech.
• Sleeping for a long time or for a little time.
• Agitation or restlessness.
• Extreme sensitivity to smell and light.
• Headache.
• Seizures or convulsions.
• Blurred vision or dilated pupils.
• Fainting, diziness or fatigue.
  Those who experience traumatic brain injury also stand at a greater risk of experiencing;
• Seizures.
• Brain bleed.
• Anxiety.
• Depression.
• Post-traumatic stress disorder (PTSD).

First aid treatment for a head injury patient.

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The first step to take after a case of head injury is usually;

• Check the person's airway, the breathing and the circulation, if possible, start a rescue breathing and CPR.

• If breathing and heart rate are normal, but the person remains unconcious, immediately treat as though there was a spinal injury, get the neck and head stablilized by placing hands on both side's of the person's head, then proceed to keep the head in line with the spine and prevent any form of movement. After that, wait for medical assistance.

• If there is any noticed bleeding, press a clean cloth on the wound, unless you are thinking there may be a skull fracture. If the injury is a severe one, act extremely careful with the head, be careful not to move the head around. in a case where the cloth places gets soaked with blood, do not bother removing it, instead, simply place another cloth carefully over the first one while you await medical response.

• If there is a suspected case of skull fracture, do not apply direct pressure to the point of bleeding, do not also attempt to remove any form of debris from the wound, then cover the wound with a sterile guaze dressing.

• In a situation where the patient is vomiting or about to vomit, roll the person's head, neck and body at once to a stabilized position, this will help prevent chocking and the spine is still protected.

• Any available ice pack has to be applied to the swollen regions.

Treatments for cases of traumatic brain injury, definitely depends on how severe the condition is, but for every case of traumatic brain injury, these treatment options could be applied.

Inracranial pressure (ICP monitor): In this case, a catheter is placed through a small hole in the skull, it is then positioned inside the ventricle, this is used to measure pressure inside the head. The ICP monitor grants the possibility of an immediate NSICU team when the pressure starts to get too high.

Neurocritical care: This is applicable as a patient's intensive care option, often for those who have suffered a life-threatening brain injury. So many patients who have a case of severe TBI are either paralyzed or comatose. The possibility of them also suffering injuries in other parts of the body is not far-fetched. The treatment process is carried out by a neurointensivist, patients are often awakened and monitored for assesment of the mental status or brain functional ability.

Brain oxygen monitor: This treament also involves, placing a catheter through a small hole into the skull, then positioning it within the brain tissue. The licox is used for the measurememnt of oxygen level and temprature level in the brain.

Ventilator: In some cases, a ventilator machine which of course, helps breathing process is required. This ventilator is connected to the patient by the endotracheal tube. This tube is placed into the patient's mouth and it goes down into the windpipe or trachea, this tube makes it possible for the machine to push air into the lungs and out of the lungs, therefore making it possible for the patient to breathe.

Feeding tube: During those moments when patients are on ventilator or they have a decreased level of alertness, it may result in their inability to eat or reduce the level of nutrition in their meals. A nasal-gastric feeding tube, may have to be inserted through the nose of the patient and then passed down through the throat into the stomach, this tube delivers the liquid nutrition and other medication into the stomach successfully.

Egg monitoring and seizures: A siezure is an electrical discharge from the brain. Majority of patients who suffer TBI, most likely experience an undetected siezure except if it is being monitored by electroencephalogram(EEG).

Surgery: This is often used in cases of intracranial hemorrhage (brain bleeding), or to reduce the pressure from brain swelling.

Counselling: Counselling for emotional support, after the accident and recovery stages, is important since a lot of people experience stress and get really worried about the involved stages of recovery. They may find it more difficult to get back to work than anticipated. Therefore, alongside other medical treatments, counselling is also advised as well.

Conclusion.

Proper rest, depending on the nature of traumatic brain injury experienced, rest is often advised, for a period of 2-3 days before getting back to normal daily activities.When it comes to the level of desired rest, it is advisable to speak with a medical expert to help you determine the level of rest needed. If you take too long to rest in a case of mild head injury, you may find it difficult to get back to regular activities, on the other hand, if you get little rest in a case of severe injury, getting right back to daily activities cold make the felt symptoms even worse.

References.

https://mayfieldclinic.com/pe-tbi.htm

https://my.clevelandclinic.org/health/diseases/8874-traumatic-brain-injury

https://www.mountsinai.org/health-library/injury/head-injury-first-aid

https://www.brainline.org/article/headaches-after-head-injuries-post-traumatic-headaches