Brain injury / concussion

[NZcaver]

Is it bad to go to sleep after a major head injury? I've heard that if you've had a head injury and vomited because of it, or had a concussion, you shouldn't go to sleep without seeing a doctor. Is this true? If so, why?

Anyone with a head injury who vomits should see a doctor immediately. If it's happening now call 911.

[Stridergdm]

Not sure why this is under "On Rope" but I agree with ArCaver.

Basically if you go to sleep, you may not wake up. Now, you may be asking what going to sleep has to do with it. It's more that once you're asleep it's hard to monitor the patient and tell the difference between normal sleep and symptoms due to the injury.

With a major enough injury, the brain can continue (even start) to swell hours later. This obviously puts pressure on the brain and causes all sorts of neurological issues. Treated sooner enough, things will be fine. If not treated soon enough, it can result in death.

Tying this into rope, if this happened say in a vertical situation (say a rock fell on the caver, etc.) I would seriously start to think about possible ways to evac the caver with the assumption they can't do their own rope work.

[Tlaloc]

First aid guide lines:

ANY injury to the head which results in unconsciousness is a medical emergency that requires evaluation at a medical facility.

[Phil Winkler]

All good advice. The original poster was likely a spammer doing a probe.

[NZcaver]

All good advice. The original poster was likely a spammer doing a probe.

Yeah, that's why I tagged it when I first saw it. Unless somebody sees any value in this topic it can probably be deleted.

[rebelfirefighter]

Something else not mentioned. Whenever you have a head injury you many times have the potential for a neck or back injury. The patient may or may not have neck or back pain right at the moment. A wrong move or twist could cripple or even lead to death. If at all possible stabilize the patient especially if the injuries are the result of a fall.

[ek]

Yeah, that's why I tagged it when I first saw it. Unless somebody sees any value in this topic it can probably be deleted.

I see value in it...especially since Stridergdm explains why it is bad to allow a patient with a head injury to fall asleep.

This may have originated as spam (which I am guessing you deleted), but it's developed into a discussion that at least six people have found worthwhile to post in. I vote against deletion (not that it's a democratic decision )...but perhaps it should be moved out of On Rope.

[NZcaver]

This topic has been moved to the Cave Rescue Forum. Kudos to all those who provided helpful advice.

[harrym]

If you are treated at a hospital for a head injury or concussion, and discharged home, you will likely receive standard advice from the physician.

Typically, someone who has been evaluated by a physician in a hospital, and discharged home from a hospital, will be sent home with someone (friend or family member). This caretaker will stay with the injured person for at least 24 hours to watch for signs of neurological deterioration, such as alterations in mental status or vomiting, or even seizures.

Typically, the injured person will be allowed to sleep all they want, and many people with head injuries do tend to sleep a lot after the injury. The caretaker's job is to stay with the injured person, keep an eye on them while they are asleep, and wake them periodically (every 2 to 4 hours) to check on their condition and mental state.

Special conditions may require alterations in the "typical" post-discharge care instructions.

As stated above, everyone with a head injury should be evaluated by a physician. You should go home with a "caretaker" only after being advised by a physician that it is safe to do so.

[self-deleted_user]

And make sure you get checked out well too, make them run CT scan (fractures, hematomas, contusions), MRI (usually done later but also important, will show blood flow), don't let them just give a quick look and "oh you are ok" because while there may be no physical signs that doesn't mean something bad isn't going on! I worked in a stroke lab for a bit and the issues with stroke is that people don't realize they have one until it is too late. It's not like a heart attack (which is the same thing, just in your heart instead of your brain) because a heart attack gives pain which tells you get to the hospital. For a stroke, you don't know it until the effects are seen hours or even days later, at which point, the damage is done and it's a matter of damage control over damage prevention. I'm serious, the scale of hours matters. Same for TBI really, hours matter. As things shut down and function is lost, they generally don't just come back. For TBI, even the symptoms can help tell where the damage is. For example, if the person has nausea that's usually indicative of something going wrong in the brain stem. Tremors or having troubles with fine movement/grasping objects would be likely cerebellum. Etc etc. (IANAD, just a neurosci grad student.)

[cavedoc55]

Gee, Do I even weigh in?
Yeah, sure, why not....
IMHO,
There is absolutely no utility in trying to keep a patient with a traumatic brain injury awake.
If a person has suffered an injury severe enough to result in unconsciousness, efforts to keep them awake will NOT alter their course.
The fear of allowing them to sleep falls into the category of "old wives tale." The image of slapping the poor injured person and shouting "Stay with me! Stay with me!" makes great drama for TV, but in fact makes little clinical sense.
The only utility in assessing the patient's level of consciousness is to monitor their course: if a patient with a head injury is initially awake and alert and subsequently cannot be awakened, that would indicate a decline in the patient's condition. BUT, keeping the patient awake will NOT alter his course or positively affect his outcome. It will make the bystanders/rescuers feel better, but it will not help the patient at all. In fact, if the patient is sleeping/unconscious, he/she is arguably more comfortable and the brain will require less energy...hence the idea of inducing barbiturate coma in brain-injured patients to facilitate their recovery.
Furthermore, within the context of cave rescue [isn't that what we're talking about?] where rescue and time to arrival to definitive care may take hours or days, then how long are you going to keep the patient awake? I have visions of rescuers taking shifts staying awake to slap around the poor sleep deprived patient to prevent him/her from sleeping because of some fear of allowing the patient to sleep [BTW, please don't do that]. He/she has to sleep sooner or later.
I cannot count the times people have arrived in the ED with well meaning by-standers or family saying, "We wouldn't let him go to sleep!" It's all one can do to smile {inwardly} and resist blurting out something to regret later.

Bottom line: allow the poor sucker to sleep: he/she will be more comfortable and their brain will require less energy. If there will a prolonged time between injury and definitive care [like, say, in a cave rescue scenario], it makes sense toperiodically awaken the patient to assess their level of consciousness. How often? It depends. Why awaken the patient every 5 minutes to assess their LOC if you can't do anything about it?

Having said all that, I agree with the other statements made in this thread: patients with a traumatic brain injury should be evaluated by a competent physician as soon as practical. The old movie image of the hero being rendered unconscious by a blow to the head, then awakening and returning to the fight is an absolute falsehood and has caused more harm to the treatment of TBI than....Saturday morning cartoons.

These are my opinions, and mine alone, arrived at after practicing medicine for 30 years [the last 20 in Emergency Medicine] and after consultation with Neurologists and Neurosurgeons [who might know of what they speak].

Stephen Mosberg, M.D., DABFM

Every situation and individual is different and must be evaluated on its own: No treatment should be started or carried out based solely on this or any other protocol. No medication, treatment, or medical device should be administered or applied without complete training in, and a thorough understanding of, the uses, limitations and possible complications of said treatment or device. The opinions expressed herein are solely those of the author and do not represent the views, opinions, treatment protocols or standards of any other individual, group of individuals, medical group or organization, hospital, other organization, the NSS or any Section thereof or any of its other Internal Organizations.

So there!