Severe Closed Head Injury ICU
By Attorney Gordon Johnson
Call me at 800-992-9447
It probably started with a phone call. Your loved one was in an accident. Life flight has taken them to a Level One trauma center. Dazed by a bizarre mix of shock, numbness and confusion, you are now sitting in the waiting room of the Head injury ICU. If you are allowed to see the injured person, you are shocked at all of the gadgets, tubes and monitors hooked up. Depending on the nature of the head trauma, they may be unrecognizable, or look just like they are sleeping. Our goal on this first stop to our web advocacy for you is to provide information and support. We will start by giving that first page in the user’s manual, the one which has the diagram of all of the parts. From there, we will offer you some choices as to where to go next, depending on whether you need more of a human connection with those who have been there before you, or just solid neuropathological information.
The first step in grasping what is going on inside the head injury ICU, is to remember that the brain is the conductor of the body’s symphony and also the coordinator of all of the body’s functions. The severe injury to the brain that has your loved one in the coma, likely doesn’t just impacted consciousness, but may be interfering with all those other functions the brain normally performed. Thus, the brain must be given as much assistance as possible from the medical personnel and equipment to assure everything continues to work.
Below is a discussion of the the equipment most commonly found surrounding a survivor with brain injury and how this stuff is used by the trauma team in helping your loved one. Not everyone will need all of this stuff, and that is probably a good sign if your loved one doesn’t. The graphic shows the location of the equipment on the patient.
A very thin tube (catheter) is inserted into one of the patient’s arteries (usually in the arm) to allow direct measurement of the blood pressure and to measure the concentration of oxygen and carbon dioxide in the blood. Arteries carry oxygen and nutrient-rich blood from the heart to tissues and organs throughout the body. Veins carry blood that is higher in waste products and carbon dioxide back to the heart and lungs. The arterial line allows nurses and doctors to monitor these levels at regular intervals. The arterial line is attached to a monitor.
Brain Stem Evoked Response Equipment
Auditory brain stem responses evoked by stimulating the brain stem with painless sound waves using headphones. These sound waves are received by the brain, and a machine is used to test whether the brain stem has received the signals.
The quality of the brain stem’s functioning in a comatose patient is thought to be an important indicator of the degree and location of brain injury. This highly specialized equipment is not available in all hospitals.
A flexible plastic tube of varying sizes for withdrawing fluids from, or introducing fluids into, a cavity of the body. Frequently used to drain the urinary bladder.
Central Venous (CVP) Line
A very thin tube which is inserted into a vein to measure the venous blood pressure (the pressure of the blood as it returns to the heart). CVP lines are inserted into veins in either the arm or the chest just below the shoulder, or occasionally on the side of the neck. The CVP line is connected to a monitor.
Tubes inserted into the chest between the lung and ribs to allow fluid and air to drain from the area surrounding the lungs. Removing this fluid and air from around the lungs allows them to more fully expand. An accumulation of fluid and air in the lung cavity can cause the lung to collapse. Chest tubes drain into a large plastic container near the foot of the patient’s bed. The patient may have one or more of these tubes in place. Nurses will monitor the comatose patient for non-verbal signs of pain.
Electrocardiogram (ECG/EKG) -
The recording made by small, round electrode pads located on the patient’s chest to monitor heart rate and rhythm. These are connected to a monitor and uses routinely in the intensive care unit.
Endotracheal Tube (E.T. Tube) -
A tube that serves as an artificial airway inserted through the patient’s nose or mouth. It passes down the throat and into the air passages to help breathing. To do this, it must also pass through the vocal chords. The patient will be unable to speak as long as the endotracheal tube is in place. It is this tube that connects the respirator to the patient.
Tape used to close the patient’s eyes. It is important that the eyes be kept moist. We do this naturally when we blink our eyes. This reflex is lost in the patient who is unresponsive but has open eyes. To protect the eyes and to prevent them from drying out, eye drops may be put into the eyes and eye tapes may be used to close them.
This is a tube (catheter) inserted into the urinary bladder for drainage of urine. This helps to monitor the patient’s fluid status and kidney function. The urine drains through the tube into a plastic bag hanging low by the foot of the bed.
A tube inserted through a surgical opening into the stomach. It is used to introduce liquids, food, or medication into the stomach when the patient is unable to take these substances by mouth.
Intracranial Pressure (ICP) Monitor
A monitoring device to determine the pressure within the brain. It consists of a small tube (catheter) attached to the patient’s skull by either a ventriculostomy, subarachnoid bolt or screw and is then connected to a transducer, which registers the pressure.
Ventriculostomy is a procedure for measuring intracranial pressure by placing an ICP monitor within one of the fluid-filled, hollow chambers of the brain called ventricles. These four natural cavities are filled with cerebrospinal fluid (CSF), which also surrounds the brain and spinal chord.
Tubing inserted into a vein through which fluids and medications can be given.
A simple wooden or plastic board usually attached with tape to the patient’s forearm. It prevents bending and dislocation of the intravenous (IV), arterial or CVP lines.
Jejunostomy Tube (J Tube)
A type of feeding tube surgically inserted into the small intestine.
A small, thick plastic bag that can be tied to the leg and collects urine. It is connected by tubing to a catheter inserted into the urinary bladder.
Monitor, Intensive Care
A TV-like screen with a continuous display of different wave forms representing different pressures and activities in the body such as blood pressure, intracranial pressure and EKG. It may also show a corresponding number for them (digital readout).
Nasogastric Tube (NG Tube)
A tube that passes through the patient’s nose and throat and ends in the patient’s stomach. This tube allows for direct “tube feeding” to maintain the nutritional status of the patient or removal of stomach acids.
Posey Vest/Houdini Jacket
A vest worn to keep the patient stationary. This is for the patient’s safety.
A machine that does the breathing work for the unresponsive patient. It serves to deliver air in the appropriate percentage of oxygen and at the appropriate rate. The air is also humidified by the respirator.
A procedure to draw off excessive fluid in the brain. A surgically-placed tube running from the ventricles which deposits fluids into either the abdominal cavity, heart or large veins of the neck.
“Space Boots” (Spenco Boots)
Padded support devices made of lamb’s wool used to position the feet and ankles of the patient. Without this support and alignment, patients who are unconscious for long periods may develop deformities limiting future movement.
Also Subarachnoid Bolt. A device for measuring intracranial pressure which is screwed through a hole in the skull and rests on the surface of the brain.
Anti-embolic stockings. Tight knee or thigh-high stockings that support the leg muscles and thus help prevent pooling of blood in the veins of legs.
A catheter (tube) similar to the Central Venous Pressure (CVP) Line. It is used to measure blood pressure and blood gas concentrations in the right side of the heart, in vessels of the lungs and in the left side of the heart.
A tube inserted into a temporary surgical opening at the front of the throat providing access to the trachea and windpipe to assist in breathing.
A weighted traction setup composed of pulleys and lines used in the care of the patient with a broken leg or spine. After repair of the fractures and application of the appropriate casts, weights are used to keep the bones in alignment.
A sensitive electronic device which detects bodily functions, such as heart rate and blood pressure, and transmits signals representing those functions to a monitor so that they can be observed.
Contact Attorney Gordon Johnson: 1-800-992-9447
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Past Chair Traumatic Brain Injury Litigation Group, American Association of Justice