Brain Injury ABCs: How ERs Handle Trauma

01 Dec 2023

Over half a million traumatic brain injury patients are treated in America’s emergency rooms each year according to recent statistics. The swift, methodical trauma response they receive can mean the difference between life and death. 

To rapidly assess and stabilize critical brain injury patients, emergency teams rely on an established trauma triage system known as the ABCs – Airway, Breathing and Circulation. Securing these vital functions first is pivotal to preventing further damage and loss of life. Finding an emergency room near you that specializes in brain trauma care can help ensure access to prompt, effective treatment when every minute counts.

A- Airway, Breathing, Circulation – ER teams focus on ABCs first to stabilize patients 

  1. Steps taken to secure the airway, ensure adequate breathing and circulation
    Endotracheal intubation may be used to establish an open airway. Oxygen levels are closely monitored and supported through masks or ventilation assistance if needed. Fluids and drugs are administered to maintain stable blood circulation to the brain. 
  2. Importance of immediate action to prevent secondary brain injury
    By swiftly acting on the ABCs, the risk of hypoxic injury or ischemia due to hypotension is mitigated – preventing secondary insults that can severely worsen prognosis. Timely response on airway, breathing and circulation can be pivotal in reducing damage in those critical first moments.

B- Baseline Assessment 

  1. Neurological exams conducted to determine level of consciousness, pupil response etc.
    Once the patient is stabilized, neurological assessments help determine the extent of the injury. The Glasgow Coma Scale grades consciousness based on eye, verbal, and motor responses. Pupillary light response also offers insight into possible brainstem damage. 
  2. Tools like the Glasgow Coma Scale are used to assess injury severity
    These baseline findings allow the ER team to gauge the initial trauma severity and triage the patient to the appropriate specialists for the required level of care.
  3. Imaging tests like CT scans are used to detect brain bleeds and tissue damage
    CT scans also detect tissue damage, brain bleeds or swelling not evident on surface-level exams. They dictate the treatment path needed ahead – whether that’s surgical intervention, ICU monitoring or other critical measures.

C- Critical Care Planning 

  1. Patients may be sent for immediate brain surgery if indicated as necessary
    If imaging reveals sizable bleeding or hemorrhaging that needs prompt surgical relief, the neurosurgery team may operate immediately to drain blood, remove clots and repair vessels – greatly improving prognosis. 
  2. Admission to Intensive Care Unit for regular monitoring of brain function
    For less severe cases not requiring surgery, patients are generally admitted to the intensive care unit for vigilant 24-hour monitoring of intracranial pressure, seizures, nerve damage and emerging symptoms. Managing elevated cranial pressure and fluid accumulation through interventions like hyperosmolar therapy or induced medical comas may be part of the ICU protocol to prevent severe lasting impairment. 
  3. Managing ensuing symptoms like seizures, fluid build-up in the brain, etc.
    The ICU clinicians work diligently to get ahead of secondary damage through optimal management of post-injury symptoms such as seizure activity, cerebral edema and more in the hours and days following initial trauma. 

D- Damage Control 

  1. ER teams work to prevent long term impairment via hyperosmolar therapy, hypothermia etc.
    In addition to ICU measures, the ER trauma team implements protective interventions like hyperosmolar therapy to reduce swelling or moderate hypothermia treatment to limit metabolic damage in the injured brain tissue. These damage control measures can greatly improve patient outlook. 
  2. Family updates provided, and social work and psychology referrals made if needed
    The hospital social workers and crisis counselors provide support to family members as they process the trauma and make difficult decisions for their loved one. Discharge planning starts early. 

Planning rehabilitation and at-home care requirements at discharge

Case managers review projected functional impacts and start planning any at-home accessibility modifications, outpatient rehab requirements, home health needs and other support systems to smoothly transition the patient from hospital to home. Connecting patients early with comprehensive rehabilitative care is key to their quality of life ahead.


Whether minutes or hours after a traumatic head injury, emergency room specialists spring into action with their systematic ABC trauma response that focuses first on securing the airway, ensuring adequate breathing, and stabilizing circulation. Their process aims to rapidly assess and treat – minimizing the risk of secondary injury. 

The ER clinicians work hand-in-hand with neurosurgeons, ICU staff, rehab medicine and other specialties to try to ensure brain injury victims receive prompt coordinated care tailored to their needs for the best possible outcome. At Memorial Village Emergency Room, we have extensive experience with the intensive, multi-disciplinary care traumatic brain injury patients require.

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