"Stay with me!"

[Ivor the Engineer]

Often in TV and films when one character is critically injured and barely conscious, another character trying to help them will at some point come out with the line in the OP.

In the real world do paramedics, nurses and physicians actually say this to a patient when he or she is struggling to remain conscious?

If so, what's the medical benefit of a patient staying conscious if he or she is, say, bleeding profusely? I'd have thought entering the lowest resource intensive state possible would be advantageous in such cases. For what (if any*) medical conditions does staying conscious improve outcome?

Does conscious willpower on the part of similarly critically ill patients affect the medical outcome?






*With the exception of narcolepsy and an increased chance of stopping a physician or nurse injecting you with the wrong drug and/or dose.

 

[macdoc]

Purely a lay person's understanding of the factors.

From a shock standpoint or a concussion keeping people alert and aware seems very beneficial.

There is also a Golden Hour factor where the body sort of decides it's all over and starts shutting down - staying conscious and alert may hold off that state somewhat in serious injury cases.

Also an alert patient may help medicos directly.
Clearly in some cases there is a "will to live" factor engaged as well tho quantifying is certainly very difficult.
Some appear to give up, others are tenacious.

Beck Wethers is perhaps the world champ at "tenacity"

http://www.badassoftheweek.com/weathers.html

If you've ever read "Into Thin Air" you'll understand....if you haven't - do so - it's one fantastic tho heartrending story.
http://en.wikipedia.org/wiki/Into_Thin_Air

In that case and others in cold water surviving then being out may help the body survive.

I think from the common view standpoint the idea you state is mostly to prevent drifting into shock which has consequences I don't fully understand.

 

[Criticalist]

From a medical professionals point of view there is no benefit to trying to artificially maintain consciousness in this setting and even if we wanted to its unlikely to be efective. We will usually talk to the patient as a method of assessing conscious level "Can you hear me?, can you open your eyes, can you squeeze my fingers etc etc" but this is purely a method of assessment. In general terms if the patient is poorly responsive it allows us to grade the severity of the injury and more immediately determine if they need emergency protection of their airway.

If someone is so critically ill that it is impairing their level consciousness, then shaking them around and yelling "You've never given up on anything before, don't you dare start now!!" is unlikely to have any therapeutic value.

 

[Kestrel]

Purely a lay person's understanding of the factors.

From a shock standpoint or a concussion keeping people alert and aware seems very beneficial.

There is also a Golden Hour factor where the body sort of decides it's all over and starts shutting down - staying conscious and alert may hold off that state somewhat in serious injury cases.

Also an alert patient may help medicos directly.
Clearly in some cases there is a "will to live" factor engaged as well tho quantifying is certainly very difficult.
Some appear to give up, others are tenacious.

Beck Wethers is perhaps the world champ at "tenacity"

http://www.badassoftheweek.com/weathers.html

If you've ever read "Into Thin Air" you'll understand....if you haven't - do so - it's one fantastic tho heartrending story.
http://en.wikipedia.org/wiki/Into_Thin_Air

In that case and others in cold water surviving then being out may help the body survive.

I think from the common view standpoint the idea you state is mostly to prevent drifting into shock which has consequences I don't fully understand.

While skiing deep powder with friends years ago, we came across a skier who was almost gone from hypothermia. He was incoherent and somewhat blue, but we kept talking to him as we warmed him up. I have no clue if it helped, but the skier did survive.

 

[Skeptic Ginger]

The Criticalist is talking about a person in an ICU where there is the benefit of Narcan, ventilators and drugs which maintain cardiovascular integrity.

For some conditions outside the hospital, keeping someone awake can mean you also keep them breathing. It depends on the reason the person is losing consciousness. If it is drugs or hypothermia, then you may be doing some good. If it is a head injury or other trauma, you may be adding to the harm.

 

[Crossbow]

Often in TV and films when one character is critically injured and barely conscious, another character trying to help them will at some point come out with the line in the OP.

In the real world do paramedics, nurses and physicians actually say this to a patient when he or she is struggling to remain conscious?

If so, what's the medical benefit of a patient staying conscious if he or she is, say, bleeding profusely? I'd have thought entering the lowest resource intensive state possible would be advantageous in such cases. For what (if any*) medical conditions does staying conscious improve outcome?

Does conscious willpower on the part of similarly critically ill patients affect the medical outcome?






*With the exception of narcolepsy and an increased chance of stopping a physician or nurse injecting you with the wrong drug and/or dose.

Well, at the risk of sounding a bit like a blaggard, I used to be an EMT and I have dealt with a few close calls over the years, and sometimes when a person is seriously hurt they may want to just give up; and if a person gives up, then it is likely that they will soon die.

And when someone says something like "Stay with me!" what they are really saying "Do not give up and die on me!" and the subtext is something like "Do not give up because if you do give up, then you will die. However, I can still save your life as long as you can just hang on a couple more minutes so do not give up just yet!".

I hope this helps!

 

[Cainkane1]

I read a story long ago about a mexican who apparently survived dehydration by the sheer power of hatred towards those who had abandoned him to die in the desert. He was discovered by two miners and eventually nursed back to health via rehydration.

 

[AvalonXQ]

I read a story long ago about a mexican who apparently survived dehydration by the sheer power of hatred towards those who had abandoned him to die in the desert. He was discovered by two miners and eventually nursed back to health via rehydration.

He would go on to become a powerful Sith, and a master of the Dark Side of the Force.

 

[commandlinegamer]

I read a story long ago about a mexican who apparently survived dehydration by the sheer power of hatred towards those who had abandoned him to die in the desert. He was discovered by two miners and eventually nursed back to health via rehydration.

I'm sure I saw a documentary about that, I think the guy's name was Tuco.

 

[Ririon]

Well, at the risk of sounding a bit like a blaggard, I used to be an EMT and I have dealt with a few close calls over the years, and sometimes when a person is seriously hurt they may want to just give up; and if a person gives up, then it is likely that they will soon die.

And when someone says something like "Stay with me!" what they are really saying "Do not give up and die on me!" and the subtext is something like "Do not give up because if you do give up, then you will die. However, I can still save your life as long as you can just hang on a couple more minutes so do not give up just yet!".

I hope this helps!

Can you die from giving up? Can you survive a lethal medical problem by not giving up? How would such questions be answered, skeptically speaking? How on earth would you conduct ethically responsible research about this?

At some point, obviously, no amount of positive thinking can help you. And at the other end, I will not die right now from sheer giving up (that would make suicide much more common and less messy).

So, what does science say (if anything) about this?

 

[Loss Leader]

Can you die from giving up? Can you survive a lethal medical problem by not giving up? How would such questions be answered, skeptically speaking? How on earth would you conduct ethically responsible research about this?

I think there's some good research about the correlation between depression and life expectancy. Depressed heart patients die sooner, IIRC. That sort of addresses the issue.

 

[Ririon]

I think there's some good research about the correlation between depression and life expectancy. Depressed heart patients die sooner, IIRC. That sort of addresses the issue.

Not really. What is cause and what is effect?

What if people who are more likely to die sooner get slightly more depressed because of that? Wouldn't that explain it just as well as the other way around?

 

[Mirrorglass]

Not really. What is cause and what is effect?

What if people who are more likely to die sooner get slightly more depressed because of that? Wouldn't that explain it just as well as the other way around?

I think it's a matter of Occam's razor. It would only make sense for impending death to depress a person if that person had some way of knowing their life expectancy is lower than that of the next guy. There's no known mechanism that would allow a person to reliably know how long they'll live, so a theory that assumes such a mechanism simply appears unnecessarily complicated.

However, it's much harder to say whether depression has a direct effect on life expectancy or whether it's through lessened exercise, unhealthy eating, worse compliance with treatment and such.

 

[Ivor the Engineer]

I think there's some good research about the correlation between depression and life expectancy. Depressed heart patients die sooner, IIRC. That sort of addresses the issue.

But is that mainly because depressed people often don't look after themselves as well as people who are not depressed?

Conscious effort and emotional state certainly affects our tolerance of pain and can allow us to push ourselves harder than we otherwise would.

 

[Loss Leader]

But is that mainly because depressed people often don't look after themselves as well as people who are not depressed?

I don't know. I think some studies may have been done on people who are actually in the hospital, so that would take away many of those factors. Theoretically, a hospital patient doesn't have to look after himself as much - the staff is doing it for him. Still, appetite, desire to exercise, and other things would still be different between the depressed and non-depressed patient in the hospital.

Mindset can and does have an effect on health. Whether such mindset includes the short term "will to live" of a traumatically injured victim, I have no idea.

 

[Crossbow]

Can you die from giving up? Can you survive a lethal medical problem by not giving up? How would such questions be answered, skeptically speaking? How on earth would you conduct ethically responsible research about this?

At some point, obviously, no amount of positive thinking can help you. And at the other end, I will not die right now from sheer giving up (that would make suicide much more common and less messy).

So, what does science say (if anything) about this?

Sorry, but I cannot cite any good studies or statistics on the issue, however from my own personal experience I would say that if a person is seriously injured and/or terribly afraid of death, then by giving up they make it much easier for death to catch up with them.

For example, in aviation there is a term called "resignation" which refers to a case where a person simply accepts that they are going to die because they know that they are in a situation that they cannot handle, and therefore they stop flying and let their plane crash. In the military, there have been many cases where people get so emotionally drained by the constant fear of death that they no longer fight for their own lives and just wait to be killed by the enemy.

I do not know if there is an equivalent term in medicine or not, however the principal is quite similar.

 

[kerikiwi]

I have no clue if it helped..

It helped you.
I am reminded of a friend who was getting having trouble with her horse which floated badly (didn't travel well in the trailer to you ignoramuses). She asked the trainer if she should talk to the horse while she loaded him. The answer : 'sure, if it makes you feel better, but it won't help the horse'.

 

[Ririon]

I think it's a matter of Occam's razor. It would only make sense for impending death to depress a person if that person had some way of knowing their life expectancy is lower than that of the next guy. There's no known mechanism that would allow a person to reliably know how long they'll live, so a theory that assumes such a mechanism simply appears unnecessarily complicated.

Nope.

It makes sense even if you do not know EXACTLY how long you and everybody else will live. If you have a serious heart condition or cancer, you know well enough that you will not live as long as the next guy. People are even sometimes given time estimates about how long they have left by their doctors.

And what about this: If you have a history of your immune system easily taking care of all that gets thrown at it, another illness or injury would not bring you down as much as a person with at weaker general health who has a history of getting seriously sick from even trivial conditions.

In this case, the optimistic person is more likely to have the better outcome, but not because of the optimism.

However, it's much harder to say whether depression has a direct effect on life expectancy or whether it's through lessened exercise, unhealthy eating, worse compliance with treatment and such.

True. But few indirect mechanisms like that would apply in an emergency situation like the OP describes.

I am not saying that depression can or does not have a direct causal impact on your physical health. It is just darn hard to measure.

And in the emergency room, how the heck can you perform a placebo controlled randomized double blind trial?

The adrenalin from being shaken and yelled at may help in some conditions.

What if you have a selection of dying patients, and you tell half of them to "Stay awake! fight it, dammit, or you will die!" and half of them "relax, nothing to worry about, we will take care of you, you are in the best hands." Maybe?

 

[Mirrorglass]

Nope.

It makes sense even if you do not know EXACTLY how long you and everybody else will live. If you have a serious heart condition or cancer, you know well enough that you will not live as long as the next guy. People are even sometimes given time estimates about how long they have left by their doctors.

But that wouldn't explain why only some of those people get depressed, and why those people tend to die faster, which is the point.

And what about this: If you have a history of your immune system easily taking care of all that gets thrown at it, another illness or injury would not bring you down as much as a person with at weaker general health who has a history of getting seriously sick from even trivial conditions.

In this case, the optimistic person is more likely to have the better outcome, but not because of the optimism.

Possibly, but again, you had to establish a new mechanism, one not implied by the data available.

True. But few indirect mechanisms like that would apply in an emergency situation like the OP describes.

I am not saying that depression can or does not have a direct causal impact on your physical health. It is just darn hard to measure.

And in the emergency room, how the heck can you perform a placebo controlled randomized double blind trial?

The adrenalin from being shaken and yelled at may help in some conditions.

What if you have a selection of dying patients, and you tell half of them to "Stay awake! fight it, dammit, or you will die!" and half of them "relax, nothing to worry about, we will take care of you, you are in the best hands." Maybe?

It could be tried; I'm not sure if it has been. Of course, it wouldn't be enough to just say a set phrase; it would have to be a real effort to keep the patient awake in one case, and lack of such effort in the other.

Obviously it's impossible to do a double-blind, or even single-blind RCT, but while that is the golden standard, it isn't the only way of producing clinically useful data. There would be ethical concerns as well; once it started to look like one thing works better than the other, the trial would have to be aborted.

 

[Ririon]

But that wouldn't explain why only some of those people get depressed, and why those people tend to die faster, which is the point.

It would explain why it is like that on average, which is the result (if not the point made based on those that result).

Possibly, but again, you had to establish a new mechanism, one not implied by the data available.

The data does not imply mechanisms. People who interpret data do. Me, I'm "just sayin'".

It could be tried; I'm not sure if it has been. Of course, it wouldn't be enough to just say a set phrase; it would have to be a real effort to keep the patient awake in one case, and lack of such effort in the other.

Obviously it's impossible to do a double-blind, or even single-blind RCT, but while that is the golden standard, it isn't the only way of producing clinically useful data. There would be ethical concerns as well; once it started to look like one thing works better than the other, the trial would have to be aborted.

Yes, it would be problematic in several ways. I don't really have a good solution here. It is more speculation than anything else on my part. But given the lack of "gold standard" data, there is room for speculation.