Stay Awake!

RobRoy · 14th March 2011, 09:00 AM

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 · 14th March 2011, 09:05 AM

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 · 14th March 2011, 09:15 AM

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 · 14th March 2011, 09:44 AM

Originally Posted by JoeyDonuts

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

Why?

Bikewer · 14th March 2011, 09:51 AM

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 · 14th March 2011, 09:58 AM

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

RobRoy · 14th March 2011, 10:02 AM

Originally Posted by Bikewer

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

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

Quote:

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.

Originally Posted by Oualawouzou

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 · 14th March 2011, 10:07 AM

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 · 14th March 2011, 10:12 AM

Originally Posted by RobRoy

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:

Quote:

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/e...cle/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 · 14th March 2011, 10:16 AM

Originally Posted by 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.

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 · 14th March 2011, 10:17 AM

Originally Posted by 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.

I think this is the thread:

http://forums.randi.org/showpost.php...10&postcount=3

dlorde · 14th March 2011, 10:18 AM

Originally Posted by RobRoy

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 · 14th March 2011, 10:20 AM

Originally Posted by Emet

I think this is the thread:

http://forums.randi.org/showpost.php...10&postcount=3

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

RobRoy · 14th March 2011, 10:24 AM

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

Originally Posted by 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.

Moon-Spinner · 14th March 2011, 10:48 AM

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 · 14th March 2011, 11:18 AM

One cannot deliver one's lines properly if unconscious.

sadhatter · 14th March 2011, 11:31 AM

Originally Posted by TraneWreck

One cannot deliver one's lines properly if unconscious.

Try telling charlie sheen that.

RobRoy · 14th March 2011, 12:53 PM

Originally Posted by sadhatter

Try telling charlie sheen that.

Sheen has a tough time delivering them when conscious.

Tiktaalik · 15th March 2011, 12:19 PM

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 · 15th March 2011, 02:18 PM

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

RobRoy · 15th March 2011, 02:42 PM

Originally Posted by Ysidro

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

No. No I'm not.

CapelDodger · 15th March 2011, 08:28 PM

Originally Posted by RobRoy

Sheen has a tough time delivering them when conscious.

His body's lost touch with the difference.

CapelDodger · 15th March 2011, 08:32 PM

Originally Posted by RobRoy

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

Quote:

"... 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 · 15th March 2011, 08:32 PM

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 · 15th March 2011, 09:14 PM

Originally Posted by JoeyDonuts

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 · 16th March 2011, 10:38 AM

Originally Posted by 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.

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.

14th March 2011, 09:00 AM	#1
RobRoy Not A Mormon Join Date: Nov 2007 Location: In the sandbox Posts: 12,141	Stay Awake! 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?
	__________________ Logic is what man stoops to when absurdity and surrealism has failed. It's shameful. – whatthebutlersaw Far an taine ‘n abhainn, ‘s ann as mò a fuaim. All your base are belong to us.

14th March 2011, 09:05 AM	#2
JoeyDonuts Frequencies Not Known To Normals Join Date: Sep 2008 Location: Parts Unknown Posts: 10,636	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.
	__________________ _{EXIT STAGE LEFT! EXIT STAGE RIGHT! THERE IS NO PLACE TO RUN; ALL THE FUSES IN THE EXIT SIGNS HAVE BEEN BURNED OUT!}

14th March 2011, 09:15 AM	#3
Corsair 115 Philosopher Join Date: Apr 2007 Location: Tranquility Base Posts: 8,588	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.
	__________________ "We choose to go to the moon in this decade and do the other things not because they are easy, but because they are hard. Because that goal will serve to organize and measure the best of our abilities and skills, because that challenge is one we are willing to accept, one we are unwilling to postpone, and one which we intend to win."

14th March 2011, 09:44 AM	#4
RobRoy Not A Mormon Join Date: Nov 2007 Location: In the sandbox Posts: 12,141	Originally Posted by JoeyDonuts Preventing shock is the most important thing, along with exsanguination. Why?
	__________________ Logic is what man stoops to when absurdity and surrealism has failed. It's shameful. – whatthebutlersaw Far an taine ‘n abhainn, ‘s ann as mò a fuaim. All your base are belong to us.

14th March 2011, 10:02 AM	#7
RobRoy Not A Mormon Join Date: Nov 2007 Location: In the sandbox Posts: 12,141	Originally Posted by Bikewer Exsanguination should be obvious; without sufficient blood pressure/volume you die. Yes, this I know. Hence why I didn't ask about it. Quote: 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. Originally Posted by Oualawouzou 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?
	__________________ Logic is what man stoops to when absurdity and surrealism has failed. It's shameful. – whatthebutlersaw Far an taine ‘n abhainn, ‘s ann as mò a fuaim. All your base are belong to us.

14th March 2011, 09:51 AM	#5
Bikewer Philosopher Join Date: Sep 2003 Location: St. Louis, Mo. Posts: 9,536	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.

14th March 2011, 09:58 AM	#6
Oualawouzou Critical Thinker Join Date: Feb 2007 Posts: 492	But what's the link between "staying awake" and "preventing trauma"?

14th March 2011, 10:07 AM	#8
dlorde Illuminator Join Date: Apr 2007 Posts: 4,647	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...
dlorde Illuminator Join Date: Apr 2007 Posts: 4,647	__________________ Simple probability tells us that we should expect coincidences, and simple psychology tells us that we'll remember the ones we notice... Last edited by dlorde; 14th March 2011 at 10:16 AM.

14th March 2011, 10:12 AM	#9
Emet Illuminator Join Date: Jun 2010 Posts: 3,395	Originally Posted by RobRoy 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: Quote: 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/e...cle/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)
Emet Illuminator Join Date: Jun 2010 Posts: 3,395

14th March 2011, 10:16 AM	#10
RobRoy Not A Mormon Join Date: Nov 2007 Location: In the sandbox Posts: 12,141	Originally Posted by 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. 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.
	__________________ Logic is what man stoops to when absurdity and surrealism has failed. It's shameful. – whatthebutlersaw Far an taine ‘n abhainn, ‘s ann as mò a fuaim. All your base are belong to us.

14th March 2011, 10:17 AM	#11
Emet Illuminator Join Date: Jun 2010 Posts: 3,395	Originally Posted by 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. I think this is the thread: http://forums.randi.org/showpost.php...10&postcount=3
Emet Illuminator Join Date: Jun 2010 Posts: 3,395

14th March 2011, 10:18 AM	#12
dlorde Illuminator Join Date: Apr 2007 Posts: 4,647	Originally Posted by RobRoy 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 Illuminator Join Date: Apr 2007 Posts: 4,647	__________________ Simple probability tells us that we should expect coincidences, and simple psychology tells us that we'll remember the ones we notice...

14th March 2011, 10:20 AM	#13
dlorde Illuminator Join Date: Apr 2007 Posts: 4,647	Originally Posted by Emet I think this is the thread: http://forums.randi.org/showpost.php...10&postcount=3 Yes, thanks. I tried searching for it, but even when I remembered the thread title, the search wouldn't find it
dlorde Illuminator Join Date: Apr 2007 Posts: 4,647	__________________ Simple probability tells us that we should expect coincidences, and simple psychology tells us that we'll remember the ones we notice...

14th March 2011, 10:24 AM	#14
RobRoy Not A Mormon Join Date: Nov 2007 Location: In the sandbox Posts: 12,141	Ahhh, excellent, here's the answer I was looking for: Originally Posted by 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.
	__________________ Logic is what man stoops to when absurdity and surrealism has failed. It's shameful. – whatthebutlersaw Far an taine ‘n abhainn, ‘s ann as mò a fuaim. All your base are belong to us.

14th March 2011, 10:48 AM	#15
Moon-Spinner Graduate Poster Join Date: Jan 2005 Location: Within a star too far to dream of Posts: 1,485	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)!

14th March 2011, 11:18 AM	#16
TraneWreck Philosopher Join Date: Jun 2008 Location: Chicago Posts: 6,414	One cannot deliver one's lines properly if unconscious.

14th March 2011, 11:31 AM	#17
sadhatter Philosopher Join Date: Jun 2009 Posts: 5,743	Originally Posted by TraneWreck One cannot deliver one's lines properly if unconscious. Try telling charlie sheen that.
sadhatter Philosopher Join Date: Jun 2009 Posts: 5,743

14th March 2011, 12:53 PM	#18
RobRoy Not A Mormon Join Date: Nov 2007 Location: In the sandbox Posts: 12,141	Originally Posted by sadhatter Try telling charlie sheen that. Sheen has a tough time delivering them when conscious.
	__________________ Logic is what man stoops to when absurdity and surrealism has failed. It's shameful. – whatthebutlersaw Far an taine ‘n abhainn, ‘s ann as mò a fuaim. All your base are belong to us.

15th March 2011, 12:19 PM	#19
Tiktaalik Half True Scotsperson Join Date: Sep 2006 Location: Colorado Posts: 1,990	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.

15th March 2011, 02:18 PM	#20
Ysidro I'm watching you Join Date: Oct 2006 Posts: 5,334	Are you sure they weren't telling the audience to stay awake?
Ysidro I'm watching you Join Date: Oct 2006 Posts: 5,334	__________________ This is a sig file. Does anyone even read this stuff?

15th March 2011, 02:42 PM	#21
RobRoy Not A Mormon Join Date: Nov 2007 Location: In the sandbox Posts: 12,141	Originally Posted by Ysidro Are you sure they weren't telling the audience to stay awake? No. No I'm not.
	__________________ Logic is what man stoops to when absurdity and surrealism has failed. It's shameful. – whatthebutlersaw Far an taine ‘n abhainn, ‘s ann as mò a fuaim. All your base are belong to us.

15th March 2011, 08:28 PM	#22
CapelDodger Penultimate Amazing Join Date: Sep 2001 Location: Cardiff, South Wales Posts: 16,744	Originally Posted by RobRoy Sheen has a tough time delivering them when conscious. His body's lost touch with the difference.
	__________________ It's a poor sort of memory that only works backward - Lewis Carroll (1832-1898) God can make a cow out of a tree, but has He ever done so? Therefore show some reason why a thing is so, or cease to hold that it is so - William of Conches, c1150

15th March 2011, 08:32 PM	#23
CapelDodger Penultimate Amazing Join Date: Sep 2001 Location: Cardiff, South Wales Posts: 16,744	Originally Posted by RobRoy Ahhh, excellent, here's the answer I was looking for: Quote: "... 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 .
	__________________ It's a poor sort of memory that only works backward - Lewis Carroll (1832-1898) God can make a cow out of a tree, but has He ever done so? Therefore show some reason why a thing is so, or cease to hold that it is so - William of Conches, c1150

15th March 2011, 08:32 PM	#24
truethat Philosopher Join Date: Sep 2007 Posts: 8,628	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.
truethat Philosopher Join Date: Sep 2007 Posts: 8,628	__________________ “Do not argue with an idiot they drag you down to their level and beat you with experience.” ― Mark Twain

15th March 2011, 09:14 PM	#25
Fnord Metasyntactic Variable Join Date: Oct 2006 Posts: 6,633	Originally Posted by JoeyDonuts 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.)}
	__________________ Belief is the subjective acceptance of a (valid or invalid) concept, opinion, or theory; Faith is the unreasoned belief in improvable things; *and Knowledge* is the reasoned belief in provable things. Belief itself proves nothing.**

16th March 2011, 10:38 AM	#26
RobRoy Not A Mormon Join Date: Nov 2007 Location: In the sandbox Posts: 12,141	Originally Posted by 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. 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.
	__________________ Logic is what man stoops to when absurdity and surrealism has failed. It's shameful. – whatthebutlersaw Far an taine ‘n abhainn, ‘s ann as mò a fuaim. All your base are belong to us.