Is there a reason for wounded people to remain conscious?

November 15, 2008 11:24 AM

Is there a medical reason for a wounded person to remain conscious, or is that just movie drama?

You know the "Stay with me, man!" bit in so many movies and TV shows? Wounded person, lying on the floor / sprawled in the alley / bleeding all over the cockpit; best buddy imploring wounded person to remain conscious; eyes close; "Nooooo!"

Do EMTs try to get injured people to remain conscious on the way hospital, or are the wounded allowed to pass out in peace?

(I ask out of curiosity. I do not have a gunshot victim on the floor of my office.)

posted by The corpse in the library to science & nature (19 comments total)

The only real medical reason I can think of is that it's good to know right at the moment that someone lapses into a coma, because that's when you know the current treatments aren't working and you need to try something different. If someone falls asleep it's hard to tell when they lapse into a coma.

In TV shows, though, I think it's pretty much the equivalent of "Don't die." Death is almost a bad word in modern America. It's rarely used on TV.
posted by ikkyu2 at 11:47 AM on November 15, 2008

Probably what the movies are referring to is shock
posted by KokuRyu at 11:49 AM on November 15, 2008

IANAD, but I've been in several ER situations (both my own and with family members). Even if you have your complete medical history written down on a card in your wallet, if you're the slightest bit coherent you'll encounter several different people along the line of treatment who will ask you the same questions: "Are you allergic to anything? Are you taking any medications? Does this hurt?" When my Dad had his heart attack, even though Mom and I were right there, the paramedics kept shouting their questions at Dad and gestured at us to keep quiet. I don't know if it's a liability thing, or if keeping the person alert and responsive has a correlation to the eventual recovery of the patient.
posted by Oriole Adams at 12:00 PM on November 15, 2008

Injury to the head can cause a concussion. According to this guy, it used to be standard medical treatment to keep people awake immediately after a concussion because it was believed that they could fall into a coma. Also, you were supposed to wake them up every few hours to make sure their conditioned hasn't worsened. This is now outdated treatment and, surprise, surprise, tv shows have not kept up with current medical practice.
posted by nooneyouknow at 12:10 PM on November 15, 2008

I don't think it has as much to do with the victim falling asleep or passing out as it does with the victim dying.

That's what I've always thought of it as, anyways.
posted by InsanePenguin at 12:28 PM on November 15, 2008 [1 favorite has favorites]

I think it's part concussion+sleep=coma, and part Stock Melodramatic Death Scene #3A.

There's also the simple fact that falling unconsious due to blood loss, etc, is generally a sign that the situation is Very Serious Indeed.
posted by Sys Rq at 12:32 PM on November 15, 2008

There is the flashlight to eyes to test for concussion.
posted by captainsohler at 12:42 PM on November 15, 2008

Seconding InsanePenguin, in most movies and such, usually when the person closes their eyes, that person is dead. So "stay with me, man" is really "don't die, man".

Though everyone else is right, in real life, there's valuable information that a person has that responding medical technicians would like to know.
posted by Brian Puccio at 12:53 PM on November 15, 2008

I always assumed that it was simply a riff on the hilariously non-scientific trope that a person can delay or avoid death if they consciously "fight it" or otherwise possess a deep will to survive, and that someone who gives up will die earlier.
posted by Rhomboid at 1:04 PM on November 15, 2008 [2 favorites has favorites]

I know from my wilderness first responder training, you want to keep the person conscious, not just because of information gathering, but it is a way to tell how they are doing.

Keeping them awake, and talking, means you can find out if they are feeling better, worse, or if besides having a broken leg, that their stomach is feeling very warm and they are feeling sleepy (internal injury, and they are going into shock). That would require an entire different course of action than just treating someone with a broken leg.

Now for EMTs (from the ones I know personally), once they are hooked up to the ekg machine, and a drip, and are considered stabilized, they still don't want to hand over an unconscious person to the emergency room techs, because that means they have to stick around and fill out paperwork, until the person comes too. And if someone does pass out after they stabilized them, I think they would try to wake them up again. Did they miss something? Was it more severe than they thought?
posted by mrzarquon at 1:12 PM on November 15, 2008

I had a lovely little trip in an ambulance this past summer following a neurological incident. They kept me awake by talking to me; it seemed like they wanted to keep tabs on whether things were getting worse. Perhaps if I'd had an obvious wound, they might have let me go to sleep because they could SEE what was happening with it, but in my case, no one knew what exactly was wrong.
posted by desjardins at 1:18 PM on November 15, 2008

Also, while in college I had a friend who had to be transported via ambulance to the ER due to an alcohol/drug overdose. They tried to keep him conscious until they could pump his stomach, so he wouldn't choke on his own vomit.
posted by desjardins at 1:20 PM on November 15, 2008

I'm an EMT.

Part of patient assessment is to determine and monitor their Level of Consciousness. This is measured using the AVPU scale (http://en.wikipedia.org/wiki/AVPU). Ideally, you'd like your patient to be Alert (and oriented to person, place, time and events - A+Ox4). Patients may only be responsive to VERBAL stimuli or PAINFUL stimuli. Patients who do not respond in any way are UNRESPONSIVE. In all healthcare situations, we strive to help the patient maintain the highest level of consciousness possible - this generally leads to the best outcome for the patient.
posted by blaneyphoto at 1:44 PM on November 15, 2008 [3 favorites has favorites]

To go along with blaneyphoto's comment, I had a friend who once wound up in the ER after an unexpected drug interaction. She didn't remember any of it — collapsing, the ride in the ambulance, being treated in the ER — but she had awful bruising all over her chest. It turns out that EMTs sometimes use a "sternal rub," where they rub their knuckles up and down your sternum to keep you conscious and measure your response to painful stimuli.
posted by adiabat at 2:03 PM on November 15, 2008

Sternal Rub is being discouraged these days for exactly the reasons that adiabat describes.
posted by blaneyphoto at 2:09 PM on November 15, 2008

Similar question about freezing to death.
posted by jamjam at 2:22 PM on November 15, 2008

...it used to be standard medical treatment to keep people awake immediately after a concussion because it was believed that they could fall into a coma. Also, you were supposed to wake them up every few hours to make sure their conditioned hasn't worsened. This is now outdated treatment and, surprise, surprise, tv shows have not kept up with current medical practice.

I had to go to the ER for treatment of a blow to the head, and I was given home treatment instructions that I should be awakened every few hours during the first night and asked if I knew my name, the date, the President, etc. That was just weeks ago.

The EMTs also talked me through the ride, but they were largely also trying to determine if I had other injuries. There was concern that I may have had a broken neck. (An MRI showed I didn't.)

I wasn't forced to stay conscious, but I ended up conscious through the entire event, from the injury to my release from the hospital.
posted by dhartung at 3:13 PM on November 15, 2008

Seconding blaneyphoto, (I had EMT training in the late '90's), but adding that cinema scenes depicting bereft characters imploring the critically ill to "stay with us!" tend to be more dramatic, immediate, and suspenseful than those featuring characters stumbling across a comatose soul.

The "Stay with Us!" scenes allow for character interaction, dialogue, and exposition ("Jack did it -- he shot me..."). But they also require audiences to accept a useful cinematic myth: unconsciousness = death.
posted by terranova at 7:17 PM on November 15, 2008

For the reasons mrzarquon says, probably. I was in an accident, and they - paramedics, ER, doctors, various people who came in my room with clipboards - wouldn't let me sleep for ... basically, things weren't sorted out and to the "okay, just relax" until they had decided what surgery to do and were putting me under. Forced, very much forced to be awake until then.

This was about 10 hours after the accident. Maybe more.

After they got me to the hospital and go the basic paperwork done, a lot of the reason for keeping me up was having tests and x-rays and mess, and being rolled down the hall for each test or x-ray or scan, and waiting for each one.

But, yes, it's like in the movies, people want to hold your hand in there and pat your hand while they say "encouraging" things. Not all these people will have a sense of humor. But that beats not having medical care.
posted by Lesser Shrew at 7:41 PM on November 15, 2008