Stay Awake!

[RobRoy]

Last night, my wife and I were watching “Human Target” and an extra was hit with a bullet, bleeding, and they had begun first aid when one of the character (I don’t recall which) told another, “Keep him awake, no matter what!”

I turned to my wife, who has a masters in bio-chemistry, and asked her why it matters if you keep someone awake after they’ve suffered an extreme trauma. She wasn’t certain, so I decided to ask the forum.

I know keeping someone awake after they’ve suffered a concussion (or suspected) is important (though I don’t know why), but does the same hold true for someone that has suffered other than head trauma? Does it matter if they pass out from the pain or the blood loss or whatever else, if first aid is being administered? Why?

Or is this just a way to heighten the sense of urgency and drama in movies and television?

 

[JoeyDonuts]

Preventing shock is the most important thing, along with exsanguination.

As to heightening drama, absolutely. It's the same way with defibrillators. They aren't depicted accurately at all.

The whole "DON'T! YOU! DIE! ON! ME!" trope? Yeah.

 

[Corsair 115]

I'm staying awake... but only because after two hours of trying to fall asleep I gave up and decided to get up and do stuff.

 

[RobRoy]

Preventing shock is the most important thing, along with exsanguination.

Why?

 

[Bikewer]

Exsanguination should be obvious; without sufficient blood pressure/volume you die.

Shock is the body's natural response to trauma; the blood supply centralizes and circulation to the extremities is reduced. However, it can become a sort of runaway situation where the entire system shuts down.

 

[Oualawouzou]

But what's the link between "staying awake" and "preventing trauma"?

 

[RobRoy]

Exsanguination should be obvious; without sufficient blood pressure/volume you die.

Yes, this I know. Hence why I didn't ask about it.

Shock is the body's natural response to trauma; the blood supply centralizes and circulation to the extremities is reduced. However, it can become a sort of runaway situation where the entire system shuts down.

But what's the link between "staying awake" and "preventing trauma"?

Yes, this is what I want to know about. Why should I attempt to keep someone awake who has suffered bodily trauma?

 

[dlorde]

This has been discussed in these forums previously (sorry, can't recall where). As I recall, the consensus among the paramedics and medics was that, in general, staying awake isn't important, although there may be specific circumstances where it is (sorry don't recall what they were).

Apologies for being so vague, but the details are around here somewhere.

ETA: Ah, found it: "Stay With Me!"

Glancing at it, I may have been misremembering...

 

[Emet]

Yes, this is what I want to know about. Why should I attempt to keep someone awake who has suffered bodily trauma?

While I couldn't find anything specific, i think it's mostly dramatic license. And there's this:

Unconsciousness - first aid

DO NOT
DO NOT give an unconscious person any food or drink.
DO NOT leave the person alone.
DO NOT place a pillow under the head of an unconscious person.
DO NOT slap an unconscious person's face or splash water on the face to try to revive him.

http://www.nlm.nih.gov/medlineplus/ency/article/000022.htm

I'm not sure one could prevent a person from slipping into an unconscious state if they've suffered enough trauma. (unless it's in the script)

 

[RobRoy]

This has been discussed in these forums previously (sorry, can't recall where). As I recall, the consensus among the paramedics and medics was that, in general, staying awake isn't important, although there may be specific circumstances where it is (sorry don't recall what they were).

Apologies for being so vague, but the details are around here somewhere.

This is pretty much what I thought too, so your vagueness is fine. A person who has suffered some head trauma and may have a concussion is supposed to be kept awake, though I don't know why on this either, but I've followed the rule the two times that I've run into the situation.

 

[Emet]

This has been discussed in these forums previously (sorry, can't recall where). As I recall, the consensus among the paramedics and medics was that, in general, staying awake isn't important, although there may be specific circumstances where it is (sorry don't recall what they were).

Apologies for being so vague, but the details are around here somewhere.

I think this is the thread:

http://www.internationalskeptics.com/forums/showpost.php?p=6579610&postcount=3

 

[dlorde]

This is pretty much what I thought too, so your vagueness is fine. A person who has suffered some head trauma and may have a concussion is supposed to be kept awake, though I don't know why on this either, but I've followed the rule the two times that I've run into the situation.

The other thread I eventually found (Stay With Me!) does mention it's easier to assess someone's level of consciousness if they're awake

 

[dlorde]

I think this is the thread:

http://www.internationalskeptics.com/forums/showpost.php?p=6579610&postcount=3

Yes, thanks. I tried searching for it, but even when I remembered the thread title, the search wouldn't find it

 

[RobRoy]

Ahhh, excellent, here's the answer I was looking for:

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.

 

[Moon-Spinner]

I believe that slapping up somebody who has just drowned will revived them, I saw it in a documentary once (or was it a James Cameron movie, I always get those mixed up)!

 

[TraneWreck]

One cannot deliver one's lines properly if unconscious.

 

[sadhatter]

One cannot deliver one's lines properly if unconscious.

Try telling charlie sheen that.

 

[RobRoy]

Try telling charlie sheen that.

Sheen has a tough time delivering them when conscious.

 

[Tiktaalik]

As an EMT for the last twenty years, I can tell you there's no protocol for keeping someone awake when treating, evaluating, and transporting, whether they are ill or injured. Consicousness checks are performed to give a score or idea of the level of consciousness, which can tell you whether the person's condition is deteriorating or staying the same (or getting better). You can't keep someone awake if they are not perfusing correctly; it won't work.

As far as waking someone up periidically after they've had a concussion, the point is to see whether you can wake them up and what their state of consciousness is at that point, so you can get them to a hospital quickly if they are deteriorating - rather than waiting until morning, say.

 

[Ysidro]

Are you sure they weren't telling the audience to stay awake?

 

[RobRoy]

Are you sure they weren't telling the audience to stay awake?

No. No I'm not.

 

[CapelDodger]

Sheen has a tough time delivering them when conscious.

His body's lost touch with the difference.

 

[CapelDodger]

Ahhh, excellent, here's the answer I was looking for:

"... 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."

Nice one, Criticalist .

 

[truethat]

Well maybe it's because they figure if the person is actively involved in their treatment they will try harder to live? Has it been proven that if you are motivated in recovery it helps your survival rate? I've heard that before but it might be woo.

 

[Fnord]

Preventing shock is the most important thing, along with exsanguination...

What about a clear airway, regular breathing, and a heartbeat? Aren't these important too?

No one expects the Emergency Technicians! The most important thing is preventing shock!

Wait ... that's not right ... we'll go back out and try again.

No one expects the Emergency Technicians! The most important things are preventing shock and exsanguination!

What's exsangulation?

Aww, rubbish ... do over.

No one expects the Emergency Technicians! The most important things are preventing shock and exsanguination, as well as determining his insurance carrier! Nurse Fang, the fluffy pillows!

_{(With apologies to those who don't get the Monty Python reference.)}

 

[RobRoy]

Well maybe it's because they figure if the person is actively involved in their treatment they will try harder to live? Has it been proven that if you are motivated in recovery it helps your survival rate? I've heard that before but it might be woo.

This is certainly what entertainment is feeding us with the, "Stay awake!" trope. However, as the experts have suggested above, this appears to be for the sake of dramatic tension alone. There is no immediate, first-aid related benefit to keeping someone awake.

Past the first aid and traumatic care is beyond the scope of my OP. I'd wager it all depends on what put you in the need of medical attention in the first place, and how motivation would aid in recovery (like physical therapy). No doubt, a physical injury will respond to physical therapy better if the patient is motivated to get up out of his/her sick bed and do what the therapist indicates. Alternately, a fatal disease is unlikely to be affected by the mental state of the patient.