One occasionally sees in movies and TV scenes where accident victims are deliberately kept conscious, with a strong indication if they fall unconscious they will die. On the other hand, in real life news stories I often see that people are placed in medically induced coma to help them recover. Why is being kept conscious desirable in some cases but not in others? Or is this business of keeping people awake just Hollywood nonsense?
Keeping someone conscious simply makes it easier to make sure they’re not developing confusion, headache, blurred/double vision or an altered level of consciousness that they didn’t have before. It is not considered necessary anymore. It’s old advice, but Hollywood doesn’t care; they’re not looking to educate, but to entertain. Now we suggest that you simply wake them up a couple of times the first night after a suspected concussion to make sure they’re not unusually groggy or otherwise getting worse, but you can (and should) let them sleep otherwise.
If adrenaline (eg epipen) can be lifesaver… then so can the persons own natural adrenaline.
So perhaps people who are alert to their deteriorating health may be able to produce adrenaline that then saves their life… If they are asleep, they may just slip away.
But also the patient staying alert and talking helps the paramedic diagnose deterioration such as low oxygen to the brain, or loss of feeling to a limb, or collapsed lung/fluid in lung ?
Been there, done that. Wish the nurses had explained the importance at the time, because I got so sick of repeating who the President was that I started answering “Al Gore” just to be a jerk.
As for induced comas, that’s typically only done when the patient’s so badly injured or infected that he/she’s unlikely to be awake anyway.
People who have been in medically-induces comas come seem to out of them traumatized and with horror stories. Lots of stories you can find on-line. The typical gist of them is: Had out-of-control over-the-top nightmarish dream-like experiences the whole time (which could have been for days or weeks or months), and some have even claimed to have long-term PTSD afterward as a result.
Some examples:
http://www.gbs-cidp.org/topic/drug-induced-coma-and-the-nightmares-during/
http://gynomite.wordpress.com/2011/02/04/coma-dreams/
Testify.
My sister was kept in a medically induced coma for several weeks to help reduce swelling when she had a traumatic brain injury (actually two of them) several years ago.
She was crossing the street (in the crosswalk, with the “Walk” light) when she was hit by a delivery truck. Her skull was fractured in the front where she hit the hood of the truck and in the back where her head hit the pavement.
There was a lot of fluid build-up and apparently the coma reduces brain activity and so reduces swelling. After about 6 weeks they brought her out of the coma but she stayed in ICU for another 6 weeks. Then she started in-patient physical therapy.
That was 8 years ago and she has made an amazing recovery. She gets around fine and mentally is probably at least 95% where she was before the accident. She has a few short-term memory issues (but don’t we all) and a couple of minor personality changes. Maybe once a year or so she has a light seizure, usually triggered by something like stress, fatigue or heat & humidity (or a combination of things).
She never reported nightmares or any bad experiences and now has no memory of her time in the hospital. She does have some memories of the PT.