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View Full Version : Why is important to stay awake for 24 hours after a head injury?



Tornadoboy
02-15-2007, 06:00 PM
I've always heard that it is vital to keep someone whom just suffered a significant head injury awake for 24 hours, but I was wondering exactly why it is so important?
Is it because you want the person to be able to tell you immediately if they are start experiencing symptoms of a brain bleed, such as feeling dizzy or numbness? Or is it that the mere act of sleeping in itself might possibly cause further complications?

A.M. Wildman
02-15-2007, 06:31 PM
I found this link while looking for an answer to your question.

http://familydoctor.org/084.xml

According to them It's not necessary to keep a person awake after a head injury. :Shrug:

I'm sure someone with a medical background will be along shortly to resolve the issue.

latoya
02-15-2007, 06:54 PM
I think its urban legend that if a person falls asleep with a head injury they may never wake up. Since when you are asleep your brain functions slow down, people think a person with a head injury will make them slow even more.

Bmwhtly
02-15-2007, 08:14 PM
So they're awake to catch any bits of brain that fall out.

But seriously, I've never heard that. It may be lore.
If it is neccesary, I would imagine it would be to monitor their symptoms.

Del
02-15-2007, 09:01 PM
It's true. They let you sleep but will wake you every fifteen minutes to make sure you haven't slipped into a coma. Personal experience.

Sarita
02-15-2007, 09:04 PM
It's true. They let you sleep but will wake you every fifteen minutes to make sure you haven't slipped into a coma. Personal experience.Same here. 2 concusions. Both times, my Dr's wouldn't let me sleep. And seriously? You just want to put your head down and nap.

veinglory
02-15-2007, 09:08 PM
When I had a concussion the doctor suggested that I go home and rest, have a nap. So he obviously wasn't worried.

MidnightMuse
02-15-2007, 09:30 PM
If they feel you have a concussion, they'll wake you every 15 minutes to measure your alertness and brain function. If they know you don't have a serious head injury (varying degrees of severity, of course) then you'll benefit most from sleep and rest.

Head injuries are very tricky things.

Tsu Dho Nimh
02-15-2007, 10:32 PM
It is NOT important ... if they are bleeding inside the skull, they will still die. And you will NOT be able to keep them awake.

That urban first-aid legend got started because people noticed that those that went "to sleep" (comatose) often died, while those they were able to keep awake usually didn't.

Rekd
02-15-2007, 10:40 PM
Same here. 2 concusions. Both times, my Dr's wouldn't let me sleep. And seriously? You just want to put your head down and nap.

Same here. I think it's that God complex and they just want you to suffer. :)

thethinker42
02-15-2007, 10:50 PM
I've always heard that it is vital to keep someone whom just suffered a significant head injury awake for 24 hours, but I was wondering exactly why it is so important?
Is it because you want the person to be able to tell you immediately if they are start experiencing symptoms of a brain bleed, such as feeling dizzy or numbness? Or is it that the mere act of sleeping in itself might possibly cause further complications?

I've had several concussions, and this has never been an issue. In fact, after my last two -- both of which happened during the same fall -- I was told to go home and, quote, "get some rest". The prescribed a bunch of gnarly painkillers too, which probably would've knocked me out had I taken them.

But then, they may not have been the brightest crayons in the box...after all, they didn't think it was necessary -- after a double concussion that resulted from a sudden loss of consciousness, resulting in slurred speech, minor memory loss, and other such problems -- to perform a CAT scan.

Del
02-16-2007, 12:07 AM
I don't think keeping you awake could prevent anything. It would have to be a matter of metabolism; like when you are too drunk, keeping you awake will help burn off the alcohol while sleeping will let you pass into coronary arrest.

But then, if you talk to an ambulance driver, they say it is the ones that go to sleep that don't make it. Tso said that they can't keep you awake and maybe that's the thing. If they can keep you awake you will be ok. If they can't, it's sianara anyway.

I'd say keeping you up is an informative action but won't prevent deterioration.

rtilryarms
02-16-2007, 12:11 AM
The nurses on the first 3 shifts are Hotties. After that they are replaced with the Goons. If you sleep through the first day, you miss out.

Tornadoboy
02-16-2007, 06:57 AM
Thanks for the help!

The reason I asked this question is because I've got a female protag whom hits her head in a car crash and is knocked senseless, perhaps even out cold for a few moments, but primarily is just left dizzy, unsteady on her feet and overall confused for a little while after the accident. Afterwards she and my male protag become holed up in a place where help will not be available anytime soon, so they are left to deal with this problem on their own and I wanted to have a realistic basis for whatever decision he makes concerning it.

The consensus seems to be that it really doesn't matter so I think I'm going to have him fall back on a personal experience where he had a concussion and was told to go home and rest, and since they are both exhausted from seeking shelter he will just let her sleep. Also I will have him agonize a bit over this decision but realize that even if it is the wrong thing to do he will not be able to help her anyway if she has internal bleeding, and figures that if she's going to die it will be easier on her if it happens while she's asleep.

And just for the record, she doesn't.

veinglory
02-16-2007, 07:06 AM
LOL you would probably get readers complaining about either choice. people have their own ideas abotu things like that. It's like when I write a wolves as having something less than superhuman senses--people complained. There seems to be a perception that they can hear sounds though metres of solid rock :)

MattW
02-16-2007, 07:43 AM
When my wife had a server injury at work, the ER doctors gave me a slip that had all sorts of signs to look for and instructions.

The staying awake thing is so that the injured person can show symptoms that might only manifest with a slow bleed or minor swelling in the brain. If nothing occurs within a day, it unlikely to manifest. If you catch anything early enough, there things that can be done to improve blood flow or prevent a stroke.

Under a doctor's instructions, I woke her up every 90 minutes the first night, asked her a few questions, checked for pupil response, and put her back to bed. That doesn't sound like an urban legend to me.

veinglory
02-16-2007, 07:45 AM
The legend is that staying awake will prevent the condition worsening. All it does is help the outside observer notice whether it is.

ColoradoGuy
02-16-2007, 07:46 AM
Most emergency departments have a "head bonk" sheet they hand out to folks with mild closed head injuries and concussions about what to look for. You could probably get one at your local ER. As people have said, the main thing we are looking for post-concussion is rising pressure inside the head, and this is best noticed by decreasing level of consciousness. Hence the need to awaken someone every now and then to see if that's happened.

50-75% of people vomit at least once post-concussion.

5KidsMom
02-18-2007, 12:20 AM
Our pediatric phone triage protocols allow for kids to sleep after a head bonk, but the parent must wake them up in 2 hours. We then have them wake the child up 4 hours after bedtime for the next 2 nights.

Chumplet
02-18-2007, 04:18 AM
What a timely thread! I should have checked before I posted my question.

This makes me feel much better. A beta reader (who is in her 80's) strongly protested my handling of the same kind of scene in my WIP regarding a six year old child in a car accident. I had the child taken to the hospital, and they did an MRI (or a scan) and monitored her overnight, although she fell asleep during the H/h's conversation in the hospital room. I can add in the waking up part. The nurses can handle it, I suppose. Is an MRI appropriate, or is a CAT scan the same thing?

Sandi LeFaucheur
02-18-2007, 04:35 AM
No, a CAT scan is not the same as an MRI. It slices the brain in a different way. A CAT scan is much quicker, for a start. (and probably much cheaper!) When my son had his snowboard accident, he had a CAT scan in the local hospital (which, Chumplet, is Headwaters in Orangeville) and when it showed bleeding in the cerebellum, was taken by ambulance to Sick Kids, where he had another CAT and an MRI. (He's had several of each since that time, since they showed his as a CVM, but that's another story...) Oh, and Chumplet, my husband and I both had MRIs in your hospital in Newmarket, since they were trying to find a genetic reason for my son's CVM.

ColoradoGuy
02-18-2007, 04:38 AM
You can slice an MRI any way you like. We often use odd slices for special purposes, but I agree the study needed here is an uncontrasted head CT. They're quick and easy.

flannelberry
02-18-2007, 06:44 AM
I think its urban legend that if a person falls asleep with a head injury they may never wake up. Since when you are asleep your brain functions slow down, people think a person with a head injury will make them slow even more.

No it is not an urban legend. With a major concussion you don't want the person slipping from a deep sleep into a coma. Minor concussion, not such a big deal.

ColoradoGuy
02-18-2007, 07:13 AM
No it is not an urban legend. With a major concussion you don't want the person slipping from a deep sleep into a coma. Minor concussion, not such a big deal.
You are confusing cause and effect. Increasing somnolence is a sign of potentially increasing pressure inside the skull -- it doesn't cause anything by itself. So yes, "you don't want it," in the sense that it could mean worse things happening. But that is no reason to try to keep someone awake artificially.

Chumplet
02-18-2007, 07:15 AM
No, a CAT scan is not the same as an MRI. It slices the brain in a different way. A CAT scan is much quicker, for a start. (and probably much cheaper!) When my son had his snowboard accident, he had a CAT scan in the local hospital (which, Chumplet, is Headwaters in Orangeville) and when it showed bleeding in the cerebellum, was taken by ambulance to Sick Kids, where he had another CAT and an MRI. (He's had several of each since that time, since they showed his as a CVM, but that's another story...) Oh, and Chumplet, my husband and I both had MRIs in your hospital in Newmarket, since they were trying to find a genetic reason for my son's CVM.

Thanks, Sandi! And Guy!

flannelberry
02-19-2007, 06:41 AM
You are confusing cause and effect. Increasing somnolence is a sign of potentially increasing pressure inside the skull -- it doesn't cause anything by itself. So yes, "you don't want it," in the sense that it could mean worse things happening. But that is no reason to try to keep someone awake artificially.

Thanks. To clarify: I'm not confusing cause and effect. I am not making the error that increasing somnolence is causing a coma- so much as the concern of sx maskin/not being aware of changes/etc. It's the simplest way of putting it for lay understanding rather than getting into a big medical/physiological discussion about it. Although admittedly my bad for being overly simple about it.

To clarify [again :)]In all of the ERs I've been in that's the info you're giving out to people. Although dh (who's doing ER work these days (I'm not)) says it's not such a big concern as of late. So, perhaps I should reframe my stance - not a myth but also not 100% common practice currently.

flannelberry
02-19-2007, 06:51 AM
Kind of depressing to already be getting out dated!

K1P1
02-20-2007, 01:29 AM
So Chumplet, if you want a real life anecdote, my kids have had 3-4 mild concussions between them, so I've been through the business of periodically waking them, making sure they were still responsive, had slurred speech, checking their pupils (to see if both still respond to light), etc.

The worst was when, about 4 hours after her concussion, my 7YO wouldn't answer me. I got more and more frantic, then she finally responded in sleepy annoyance, "Mom, why do you keep asking me the same questions over and over?" Well, dammit, I wouldn't if she'd just answered... :)

Lolly
02-20-2007, 01:38 AM
This is a timely thread. The other day in our local newspaper I read a column written by a doctor, where he exploded common medical myths. He pretty much said what others have above: let the person sleep if need be, but wake them up at frequent intervals to check on them.

Chumplet
02-20-2007, 01:48 AM
Well, it looks like I'm on the right track with my WIP. Thanks, everyone! (Even though it wasn't initially my question! We like to share...)