There’s a paradox about concussions that I was reminded of when reading a Hogan’s’ Heroes fanfic on fanfiction.net, that also occurred in a MAS*H episode once where Alan Alda pretty much did it solo (and did a great job.)
That paradox is this - I’m very familiar with concussions where people are out for a minute. There can be nothing wrong, though, except for needing to be out of service a wihile and not remembering the game in which they got dinged years later.
However, in these stories, they showed that people with head injuries would posibly never wake up if they lost consciousness. Is it the loss of blood that’s different from a regular cnocussion (ISTR Hawkeye did have that fromt he jeep accident int hat one ep.) or what? Is a concussion any head injury, or might these be different types, where the person seems okay for a while and then just fades out?
IANAD, but the danger I’m aware of is that a head injury may bleed very slowly, resulting in crisis some hours after the initial injury. Meanwhile, the injured person feels more-or-less OK.
So if the injured person retires for the night, and the crisis occurs while they’re asleep, the transition from sleep to coma to death looks a lot like sleeping. So nobody notices any change in time to help. And if they’re at home so everyone else in the house goes to bed, well then there’s nobody even watching.
Hence the usual stay in the hospital overnight “for observation” where somebody’s on duty to watch, and they can hook up enough monitoring gizmos to tell sleep from impending coma.
Sleeping isn’t a problem, but to be sure there isn’t an on-going injury, a subdural bleed, for example, the person must be awakened every hour or more to be sure they haven’t developed other symptoms. A concussion is just that, the brain bounced around a little or a lot. It may cause no other injury. If you bump your knee, it doesn’t always bruise, even it it hurts. The same is true of the brain. The problem is, when ther is an injury, your knee can swell up as much as it will, but your brain is locked in a box. Inside that box is brain, blood and cerebral spinal fluid, there isn’t room for much more. If bleeding or swelling occurs, it can push the brain into the hole the spinal cord goes through, causing unconsciousness, and possibly death, if not dealth with.
Subdural bleeds can be rather slow. Symptoms may not appear for several hours.
If the person is awake, and suddenly loses consciousness, they may not ever wake up, but just falling asleep isn’t a problem unless they can’t be reawakened.
The media gets most medical stuff wrong. I don’t know why.
Apparently (according to my wife, who is a nurse), there are genuine reasons for trying to keep a possibly concussed patient conscious; these include (but are probably not limited to): The complete reliance on autonomic systems while asleep (when you are awake, you can consciously control and maintain your breathing) and things like lowered blood pressure etc when sleeping.
Yeah, I would be those “gizmos.” Waking someone up, asking a series of questions, and doing some physical tests every hour is what happens.
The questions are, for adults, along the lines of “Tell me your name” “What city are we in?” “Where are we?” “Who’s the president?” Once, after a recent move I kept telling my patient we were in Washington, but he kept telling me we were in California… he was right.
The other tests might be having the patient squeeze my hands, press their feet against my hands, show me their teeth. Traditionally shining a light into the eyes is obligitory, but pupil changes are a late sign, so if they are awake, there’s no need.
I was so concussed that I couldn’t remember the accident, the ambulance, the x-rays, people’s names and they still sent me home. Love those budget cuts to over-funded public health care.
I don’t know why.