Should We Fight to Stay Conscious During an Injury?

[lisab]

We've all seen in the movies and pop culture where a person has been injured and is urged to fight to stay awake. Is there a medical justification for this? If someone is injured and waiting for medical care, should they fight to stay conscious? Why? Can this really delay or avoid death?

 

[Monique]

A reason why is that if someone is awake they can answer medical questions, another is that it's easier to tell when the condition is deteriorating (when the person does loose consciousness vs. someone already unconscious and slipping into a coma).

I'm not sure whether the 'fighting spirit' helps in getting a better outcome. In some cases doctors choose to keep injured people in an artificial coma, so clearly in some cases it's better to have the body be in control over the mind.

 

[phinds]

I know nothing about medicine and am just talking off the cuff, but what occurs to me is that "fighting spirit" aside (and I DO think that could be a good thing) being awake and aware that you are in serious condition could be very detrimental to the healing process since you are likely to be screwing up your body chemistry in a way that would not happen if you were just asleep and let the natural body defenses take over. I'm certainly open to correction on this.

 

[Number Nine]

I don't imagine it would make much of a difference. There's already a fair bit of research suggesting that "fighting spirit" makes no difference in the progression of cancer, and I can't imagine why unconsciousness would be any different. When the biochemical processes supporting consciousness are disrupted, then your "will" makes no difference because those same processes were underlying your capacity to have a "will".

 

[I like Serena]

When a person has serious wounds, it takes immediate attention to see that the most important issues are dealt with asap.
Lack of oxygen to various parts of the body is a condition that will keep getting worse.
Typically people with serious injuries will go into some sort of shock state.
A typical treatment for various types of shock appears to be epinephrine which is usually injected.

I suspect an induced coma would only be used if everything is known, under control, and carefully monitored.
They can always inject epinephrine if needed.

Without epinephrine at hand, having people "fight" for their lives seems a reasonable substitute.

 

[Pythagorean]

When I got hit in the head when I was younger, the doctor made my parents wake me up every couple hours to make sure I didn't have a concussion... no idea of the mechanism or motivation, just an anecdote to spark a more informed thought.

 

[Monique]

The waking was to make sure your condition didn't worsen, there could be swelling or bleeding that is monitored by checking the responsiveness of the patient.

Apparently these days brain scans are taken as a precaution, in that case there is no waking advice (since a dangerous injury has been ruled out).

 

[zoobyshoe]

People in danger of freezing to death can forestall their demise by staying awake and staying in motion. Maybe this has been misapplied to other situations?

 

[Pythagorean]

Ah, so it wasn't necessarily a helpful mechanism for recovery, possibly even slightly stressful in term of needing rest for recovery, yet still important for diagnosis for early intervention.

 

[Evo]

TV shows are apparently going by the old myth that a person that suffered a concussion needs to remain awake. Pyth, this also answers why your parents were told to wake you occasionally.

It has long been thought that a person with a concussion should not sleep because they might slip into a coma or lose consciousness. Through research ... we now know that there is no need to make a patient with a concussion stay awake.

If the person who is injured is awake and holding a conversation, you can let him or her fall asleep as long as they are not developing any other symptoms such as dilated pupils or issues with walking. "Usually after a concussion, a person may be dazed or may vomit,” explains Dr. Alexander. “For children, we advise parents to wake up the child a couple times during the night to make sure they are able to be aroused."

http://www.uamshealth.com/?id=10724&sid=1

 

[Monique]

you can let him or her fall asleep as long as they are not developing any other symptoms such [..] issues with walking

Sleep walking or what?

 

[Pythagorean]

People in danger of freezing to death can forestall their demise by staying awake and staying in motion. Maybe this has been misapplied to other situations?

I would classify this as a "button pushing" scenario. The basic idea being you have to be conscious to push the button to keep yourself alive (or in this case, generate heat. Treading water to keep from drowning would be another example).

 

[lisab]

So it seems there are two pathways after severe injury:

Injury → Loss of consciousness (i.e. sleep) → Eventual Recovery

Injury → Loss of consciousness (i.e. coma) → Death

And fighting to stay awake does not determine which path you're on. Is this correct?

 

[jim mcnamara]

Here is a clinical research paper that discusses clinical outcomes for patients with traumatic brain injury, deals with sleepiness.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1978308/

Lisab -

You decide. I am not qualified to comment.

 

[Evo]

Sleep walking or what?

Lol!

 

[Evo]

Here is a clinical research paper that discusses clinical outcomes for patients with traumatic brain injury, deals with sleepiness.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1978308/

Lisab -

You decide. I am not qualified to comment.

But this is about post truma patients, the subjects had at least three months pass since the incident. Interesting study though. I think lisa was asking more about tv shows telling injured people to remain awake while they are going into an ambulance, or the time immediately after the accident.

 

[0xDEADBEEF]

I believe that staying conscious may actually help, for a number of reasons. If a person is fighting the body releases adrenalin, which is also given as standard medication for reanimation. Wikipedia says it is not proven to work (I guess since it is hard to justify doing a control group if most paramedics swear by it). Adrenalin seems to have effects of centralizing blood circulation and such things, and works against deadly shock. First aid is mostly a way to keep the heart pumping and the lung breathing of a body that is potentially dying, this has the top priority until a person can be hooked up to the machines, any other damage is secondary, and I suppose fighting helps here. But what is more and more hard to discuss is all that placebo stuff. A mother who is wounded who needs to bring her child to safety may have better chances of survival than someone with less motivation. Most people get ill after the exams, when the stress is over, not during the stress. So I don't know if we really understand enough about biochemistry to judge.

 

[DiracPool]

We've all seen in the movies and pop culture where a person has been injured and is urged to fight to stay awake. Is there a medical justification for this?

Yes, there is a medical justification for this. It is called, "if I'm awake, I know I'm not dead." The null hypothesis here is that there is every reason to maintain "awakeness" and awareness if you are in a medically compromised situation, and zero reason to fall asleep and maybe not ever wake up again.

So, in short, I'd say the only reason to not maintain awakeness would be if a medical team were already on the scene and had some reason to put you out.

 

[Evo]

A reason why is that if someone is awake they can answer medical questions, another is that it's easier to tell when the condition is deteriorating (when the person does loose consciousness vs. someone already unconscious and slipping into a coma).

This seems to be the most logical reason for someone to be conscious, if the patient is awake, they can answers questions like "Can you feel this?", if they can't, and they should, it gives the medical personnel clues as to potential problems.

 

[jim hardy]

I've had heart attacks , blacked out and flatlined three times.
Each time the nurses slapped my face saying "come back stay with us open your eyes say something".
I distinctly remember fading out into blackness and being pulled back awake by the encouragement from those wonderful nurses.

I think that staying conscious somehow encourages your body to not go into shock and die. Getting patient to say something makes them use their lungs, which perhaps restarts breathing.

That's the view of this layman. Perhaps somebody from medical community has experience to share?

old jim

 

[Pythagorean]

I wonder if adrenaline secretion happens in the unconscious and if that could be a factor. Not just adrenaline in particular, but hormone secretion in general. Are certain hormone secretions only available when the waking circuits aren't being inhibited?

 

[Monique]

Yesterday I was watching a television program about a neonatal care unit, there I found the answer to the OP question

There was an early born baby with underdeveloped lungs that had to work hard to breathe and get enough oxygen. Babies get fatigued after a while, so the doctors decided to intervene and help the baby with breathing. For that they wanted to intubate her and to reduce the stress of the procedure they first put the baby to sleep.

During that time the doctor was explaining that putting the baby to sleep is necessary, but it is very dangerous as well: the baby won't fight for the breathe anymore and so the doctor needs to be confident that they can intubate the baby quickly or otherwise the situation could become dangerous.

So yes, even in premature babies being conscious and fighting is important for survival. At least when breathing is concerned, it's probably an evolutionary mechanism since people with breathing problems during their sleep also wake up to catch their breath.

 

[lisab]

OK, that makes sense. There is definitely a difference between the way someone breathes when awake compared to sleeping.