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The treatment of head injuries depends on the type and the severity of the injury determined by the clinical examination and imaging tests.
In case of minor head injuries usually there are no symptoms except for pain at the site of injury. In these cases, only pain killer such as acetaminophen is given and rest is advised. NSAID’s pain killers such as ibuprofen and aspirin needs to be avoided to prevent any chances of worsening of bleeding in the brain if present.
An open skin cut associated with head injury is stitched with sutures and covered with bandages. Severe head injuries or head injuries with worsening symptoms need immediate medical admission and specific treatment.
It is very important to begin treatment as early as possible with some cases needing early surgery to prevent further worsening and reduce chances of death. Some cases doesn’t need surgery and are managed in intensive care unit (ICU), specialized in such cases providing neurocritical care.
The treatment for these cases can include:
It is a special care given to patients with life threatening TBI in ICU. The care is given under the supervision of neuro-intensivist who are doctors specialized to provide medical care for such patients. These patients generally have severe brain injury along with injuries of other body part. These patients tends to have significantly affected critical body functions such as heart rate, blood pressure, breathing rate and oxygen saturation which needs to continuously monitored and managed. This is done by number of medical devices which can be as follows:
• Ventilator: some patients may not be able to breath on their own. These patients are put on ventilator which does the functioning of inhaling and exhaling for the person.
• Monitors to assess blood pressure, breathing rate, oxygen saturation, pulse rate and electrical activity of heart.
• Intracranial pressure (ICP) monitor: a small catheter is placed inside the head to monitor CSF pressure which can alert the doctors in case of increased ICP.
• Feeding tube: is inserted through the nose into the stomach to provide feed or any medicine in form of liquid.
• EEG: to monitor electrical activity of the brain to detect seizure in these patients.
• Sedatives and painkillers: in severe brain injury these medicines may help by inducing relaxation, avoiding altered or agitated behavior and to prevent pain.
• Diuretics or medicines to control ICP: the medicines help to reduce swelling in the brain and to manage intracranial pressure. They act by withdrawing excessive water from the brain to be excreted into urine.
• Anti- seizure medicines: are given to prevent seizure in these patients who has high tendency to develop seizure during the first week after the injury.
• Antibiotics: these are given to prevent or treat infection.
Surgery may be mandatory to remove large blood clots producing significant mass effect, repair skull fractures and bleeding vessels. It can also be performed to relieve increased intracranial pressure.
Following surgeries are done in such cases:
Burr hole and removal of clot: a small hole is made into the skull bone and the clot is drained out. Generally done in cases of epidural hematoma.
Craniotomy: a part of the bone is removed and the repair of the affected part is done such as skull fracture, removal of blood clots or repair of vessel. The bone is then repositioned with screws.
Craniectomy: in cases where there is too much pressure developed inside the head, a part of the skull bone is removed to reduce compression on the brain. This allows the swollen brain to get enough space. A special tissue is placed on the exposed brain and the skin is closed. The removed part of the bone is placed again after 1 to 3 months once the swelling has reduced called as cranioplasty. Along with this sometimes the clot or bleed is also removed to reduce the pressure.
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