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Acute Care and Rehabilitation


Lt Col Reynolds
Emergency medical treatment and time in the intensive care unit, or ICU, are usually the first line of treatment of moderate to severe TBI. The focus in emergency treatment and the ICU is to discover and resolve any immediately life-threatening conditions and to stabilize the patient. After that, acute rehabilitation begins. Dr. Green, what can you tell us about emergency treatment, the ICU, and acute care?

Dr. Green
Well, Dr. Reynolds, emergency medical treatment can include unblocking airways, helping with breathing, and keeping blood circulating. Emergency personnel work to administer oxygen as quickly as possible after the injury to help reduce the risk of additional damage to the brain. Cardiopulmonary resuscitation, or CPR, may also be necessary. Steps are taken to control blood loss, replace lost blood with fluids, and prevent or treat other complications.

Moderate to severe TBI patients may then spend days or weeks in the ICU. Severe TBI patients may be in a coma and medically unstable for a long time. They may need a ventilator to help them breathe and IVs to deliver medications and fluids. They will also be attached to medical equipment that monitors their heart activity, their blood pressure, and the level of oxygen in the bloodstream.

A device called an intracranial pressure, or ICP, monitor is inserted into the patient’s brain to monitor the amount of pressure inside the skull. If the brain swells too much, steps will be taken to reduce the pressure.

Once a patient is stabilized, they enter acute care or acute rehabilitation. This stage of treatment takes place in a special unit of the trauma hospital, a rehabilitation hospital, or another inpatient setting. Acute rehabilitation is a significant phase of the recovery process for many severe TBI patients. Therapy may take place five to seven days a week for three or more hours a day to help the patient regain the ability to do everyday activities such as dressing, eating, going to the bathroom, walking, and speaking.