Stages of a brain injury

If anyone has been knocked out, they need urgent medical attention, regardless of whether they have said they are 'fine'. You cannot see a closed brain injury. The person might vomit, they might say they have a headache, they might be confused, their speech may be slurred, they may become violent... these are the warning signs. Even if there are no symptoms, you have not got x-ray eyes, you need to call an ambulance, that person urgently needs to go to the hospital and the hospital need to be told that the person has a suspected head injury, it is life-threatening. 

You may be thinking, 'why is it so serious?'. We have one brain, one brain only. If that brain dies, you're dead and if that brain is damaged significantly, that person will have a lifelong disability. 

What is happening in the brain when it is damaged? The injury happens in stages and the stages can last up to 48 hours. The first thing is the impact. This will cause some of the neurons in the brain to die and those functions will be lost. When the person recovers from this, other damage is going on. As the neurons die, they give out toxins which will cause other neurons to die, leading to more toxins being released. 

The white blood cells, very helpfully in the blood, will rush up into the brain and try to mop up these toxins. In doing this, the brain will swell. The brain has nowhere to go when it swells because it is in an enclosed box, the skull. What the medics in the hospital will do is either drain some of the fluid from the brain by putting a stent in so that the brain doesn't swell, or they will have to take them to theatre and remove part of the skull so the brain has room to swell. Later on, when the person has made a recovery, they will either put the bone back or put a metal plate back. 

Very often, the medics will put someone in an induced coma, that when the brain is not active. The only way the brain can rest is if we are asleep, therefore by putting someone in a coma, the brain is not being stimulated and will not swell as much as it would if they were conscious. This effect can go on for hours into days, which is why it is important for someone to be in hospital being carefully monitored.