Testing and diagnosis
When a patient enters the ER with a possible head injury among other injuries, after stabilizing bleeding and other injuries, it is imperative to immediately and accurately determine the degree of trauma to the brain. This may be accomplished by performing a magnetic resonance imaging scan (MRI), Single Photon Emission Computed Tomography (SPECT), Computerized Axial Tomography (CAT) Scan or a Positron Emission Tomography (PET) to determine injuries to the head or other vital parts of the body that may have been suffered injury during the event. When there is a blunt-force trauma to the head or skull, the brain may have moved somehow inside the skull’s brain case and been pushed against it. Such movement may cause the brain to swell, which is life-threatening to the patient. In cases like this, it may be necessary to limit neurological activity to stem the swelling. This is typically done by inducing a coma. Once the area and degree of possible swelling is determined, It may be determined that surgery is necessary and removal of one or more of the bones in the skull. To do this, exact measurements should be taken of the bone or bones removed before placing them in a highly-sterilized refrigerated storage container for replacement after swelling has subsided and it is determined the patient has significantly healed from the initial surgery. That surgery may involve replacing the bone plate with an artificial plate in the exact measurements of the original bone plate.

Meeting with the family
In the opening hours of an emergency involving a possible brain injury, you as the doctor will be confronted with the survivor's family members and friends all inundating you with nervous questions about their loved one’s condition. Usually, you would start with the guardian or spouse in conveying confidential information about the Survivor. How you convey this information may affect the family’s trust in you as the medical professional, which will inevitably affect their decisions on the survivor’s treatment. While doing so, you may have to gather accurate statements from family members and witnesses to the event, to determine how to proceed further.
Clarity and Concision mixed with gentleness














Most likely, the family has never been in a situation where they had to take into account the severity and complexity of a traumatic brain injury and all that is involved with the treatment and recovery. You should clearly explain to them the details of a traumatic brain Injury and the types of treatment for that condition without confusing them with too much medical jargon that they have no way of relating to. The present family should know how important it is be aware of every test or examination to diagnose the patient and why those tests and procedures were necessary in diagnosing the patient or further preparing him or her for surgery. If it is possible give the appropriate family member a written log of these activities to keep for their records and information. They may have problems recalling the details themselves due to the stress of the situation.
The details of a traumatic brain Injury can be very involved and gruesome. While it is important to be thorough in presenting your information, you must be careful not to overwhelm the family by going into too much intricate detail. In your attempt to be direct and clear with your information, you should be gentle and considerate in issuing any details about your patient. There is no need to cause family member to worry unnecessarily about their loved one.
​Optimism vs. Pessimism vs. Realism
Undoubtedly after informing the family of the survivor’s condition, they will most likely ask if their loved one will be normal again after the healing process. Answering questions like these can be tricky. No doctor, no matter how good he or she is can precisely predict exactly how a patient will do during the healing process and if certain impairments caused by the injury are permanent.
The truth is that with all the studies and progress that has been made in the arena of traumatic brain injuries and the field of neurology, the outlook of a Survivor receiving proper care during a Traumatic brain Injury is increasingly positive. That being said, it is always important to give the family realistic expectations about what the survivor may be dealing with and what the patient’s future may look like. You should be gentle, precise and be aware of the need to be cautious when discussing negative aspects about the patient’s condition with the patient in the room while not conscious, because the patient can likely hear a great portion of the activity around him or her while unconscious. Hearing devastating negative information in a comatose or semi-comatose state may negatively affect the patient’s mind and their overall recovery from their brain injury and from any other life-threatening injuries.
Where is your patient’s mind while unconscious or semiconscious?






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Rarely, patients emerge to consciousness after a severe neurological event like a traumatic brain injury, fully aware of what has transpired. You should keep in mind that the survivor's mind may be in an altered state of consciousness. It is difficult to tell just where that patient’s mind is. The mind may be either stuck the subconscious (in a state of dreaming, unable to connect the present with reality) Due to the extent of the trauma to the brain, or the effects the possible coma-inducing drugs. The extent of the trauma may have left the patients locked inside themselves, unable to speak, move or respond (however the patient is able to think). The patient may emerge from their state of unconsciousness with a form of dementia. During this time after the surgeries, it is up to a neurologist to get the patient to respond to different simple commands. A good approach to determining how or if their verbal communication skill have been impaired is to try to make them form simple sentences or through simple well-known songs like Happy Birthday or Twinkle, twinkle little star.
Softly playing familiar, relaxing music while the patient sleeps my help bring the patient from the state of being trapped in their subconscious.
Later, after neuropsychologist and the neurologist can determine if the patient is ready and decides if further treatment is necessary, the patient may be transferred to a rehabilitation facility.
Emergency Care
