When a suspected spinal cord injury occurs, it is important not to move the injured person unless absolutely necessary until qualified emergency medical personnel can evaluate the situation. Moving the injured person before stabilizing the injury can cause additional damage to the spinal cord. If the person is in immediate danger and must be moved, immobilizing the head and neck first may minimize the risk of additional injury.
Emergency medical treatment for brain or spinal cord injury can make the difference between recovery and permanent disability or death. In cases of severe brain or spinal cord injury, a person may stop breathing, and his or her heart may stop beating. Cardiopulmonary resuscitation (CPR) can keep the person alive until emergency medical help arrives. The emergency medical technicians (EMTs) or paramedics will immobilize the injury, stabilize the patient’s heart rate and breathing, take measures to prevent shock, and transport the patient to an emergency room.
In the emergency room or intensive care unit, the physicians and other health care professionals will continue to work to stabilize the patient’s blood pressure, heart rate, breathing, fluid and electrolyte balance, and pressure within the skull or spine to promote healing. Mechanical ventilation may be required, and drugs may be administered to reduce inflammation and pressure on the nerves in the brain or spinal cord.
Mild head injuries can be treated at home. Mild headaches caused by minor blows to the head can be safely treated with acetaminophen to relieve the pain. Nonsteroidal anti–inflammatory pain relievers such as aspirin, ibuprofen, or naproxen should not be taken because they can make any bleeding inside the brain worse. If you or someone you are with loses consciousness after an injury, however briefly, or have any of the other symptoms of a serious head injury [
Table 1], you should seek medical care immediately.
Mild whiplash injuries can be treated with bed rest and regular monitoring. Medical evaluation and treatment should be sought whenever spinal cord injury is suspected. If, upon examination, the injury is minor and confined to the muscles or ligaments supporting the spine, bed rest and regular monitoring may be the only treatments needed.
Seek medical care if you start having signs of complications from your head injury Table 04. Even if your head injury was not serious, new symptoms and unexpected complications can develop hours or even days after the injury. The first 24 hours are the most crucial, and you should remain with a reliable companion during this period.
If there is a swelling at the site of injury, apply an ice pack, making sure that there is a cloth or towel between the ice pack and the skin. If swelling increases markedly in the spite of the ice pack application, call your doctor or go to the hospital.
Table 4. Signs of Complications of a Head Injury
Feeling drowsy, or having an unusally difficult time waking from sleep Nausea or vomiting Having seizures or convulsions Clear fluid or blood draining from the ears or nose Severe headaches Numbness, weakness, or decreased movement in an extremity Feeling confused, or behaving strangely Visual disturbances or changes in pupil size (unequally-sized pupils) A very slow or very rapid pulse, or an unusual breathing pattern
Your doctor is the best source of information on the drug treatment choices available to you.
Speech therapy, physical therapy, and occupational therapy may help people with brain or spinal cord injuries to recover and live independent lives. Many people who have impaired speech as a result of an injury can benefit from intensive speech therapy. Physical therapy can help to maintain muscle tone, avoid atrophy or weakening of the muscles, and improve circulation. Occupational therapy can help an injured person learn how to perform practical tasks and live as independently as possible.
Support and counseling may help people cope with their changed circumstances after severe brain or spinal cord injury. It is common for a person to experience depression, anxiety, and other behavioral changes after a severe brain or spinal cord injury. Professional care and support may help the injured person adjust to his or her new circumstances. In some cases, antidepressants, anti–anxiety drugs, or drugs designed to reduce agitation may help as well.
Surgery may be required to relieve pressure in the brain or spinal cord. Increased pressure in the brain or spinal cord is a serious complication of traumatic injury. In fact, the pressure caused by swelling following the injury may cause more nerve damage than the original trauma. Surgery may be required to open the skull or spine to relieve the pressure. Blood clots in the brain may also accompany head injury. In these cases, surgery may be required to remove the clot and ensure adequate blood flow to all the areas in the brain.
Surgery may be required to treat penetrating head injuries Figure 02. In the US, gunshot wounds are the most common cause of penetrating head injuries. The amount of damage depends on the caliber of the weapon, the distance from which it was fired, the type of ammunition used, and the trajectory of the bullet. Surgery may be required to remove the bullet or bone fragments from the brain, repair damaged blood vessels, and close the wound.
Surgery may be required to realign damaged vertebrae after spinal injury. If the spinal injury damaged the vertebrae or caused them to be dislocated, surgery may be required to stabilize the bones, to remove bone fragments from the spinal cord, or to realign the vertebrae to prevent any additional damage to the spinal cord.
Figure 02. Gunshot Wound
Athletes who suffer concussions as a result of contact sports must seek a doctor’s advice about whether they can return to the sport. Athletes who have had a concussion are at increased risk of having another concussion, and of having brain damage as a result of subsequent concussions.
Doctors must follow standard guidelines when managing athletes who have suffered concussions. According to the severity of, and number of concussions suffered, a doctor may recommend that an athlete stay on the sidelines for the remainder of the game, not return to the sport for the entire season, or refrain entirely from that particular sport or any collision sport.
Most people with a minor head injury recover completely within a few days. While the prognosis for more severe injury is difficult to predict, about half of people who experience severe brain injury survive. It is possible for people who survive a severe head injury to experience near–complete recovery. This is because many brain functions can be performed by more than one area of the brain, and uninjured areas sometimes take over functions of regions that have been lost. This process, however, is unpredictable. It may take years, and some residual disability usually remains. Some brain functions, such as vision and limb movement, can only be performed by specific brain areas, and damage to these regions usually results in permanent loss of function.
The most severe cases of brain injury may result in permanent paralysis or coma. Persistent total unconsciousness, also known as persistent vegetative state, is the most serious consequence of nonfatal head injury. It results when the upper brain (the part that controls high–level mental function) is destroyed, but the thalamus and brain stem (the parts of the brain that control breathing, temperature control, heart rate, etc.) are uninjured. If the state lasts for more than a few months, it is highly unlikely that the person will ever regain consciousness.
The prognosis for spinal injury depends on the extent of the injury. Spinal injury involving only muscles and ligaments is likely to resolve completely within several weeks. Spinal fractures usually heal within two months. Rehabilitation and physical therapy may reverse some paralysis. If the paralysis lasts for more than six months without improvement, however, it is likely to be permanent.
The frequency of follow–up depends on the nature and severity of the original injury. Minor head or neck injuries generally do not require follow–up. People with more severe injuries should undergo regular follow–up to monitor recovery and to look for signs of potential complications.
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