# Stupid question; Patient feels like they want to sleep



## Hockey (Jan 11, 2009)

I've always been told to try and keep a person awake if they fall, get hit in the head with something, crash or anything like that.  


During my basic class, our instructor told us if the patient really wants to "sleep", "rest", let them.  


I can see both sides of this so I'm wondering what do you do?

Let them sleep, because if they are going to slip into a coma, telling them not to sleep is not going to prevent it.  I can also see why not to so you can monitor their LOC.

I do my best to keep the patient awake but it always stays in the back of my mind what he said...


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## Ridryder911 (Jan 11, 2009)

Only on t.v. does one describe of not letting one sleep, or having the ability to "talk one out of shock". What one is concern is the altered level of consciousness and the difficulty arousing or awakening one up. Again r/t LOC. 

If a head injury wants to sleep, the only reason I attempt to keep the awake is monitor their alertness and degree of LOC. other than that... sleep. 

R/r 911


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## MMiz (Jan 11, 2009)

It is my belief that it's essential to keep the patient awake in order to appropriately evaluate a patient's condition/status.

Letting the patient "sleep" serves no one.


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## mikie (Jan 11, 2009)

So [not necessarily in an EMS patient-care scenario], but if you suspect someone with a head injury, the 'rumor' for going to sleep (being bad) is false?


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## IcantThinkofAname (Jan 11, 2009)

I also think the don't-go-to-sleep thing isn't meant to apply when someone is in emergency care, on oxygen, etc.  I mean, I certainly hope that if someone is at home with a severe enough head injury that they will be taken to the ER, however, once they are in emergency care and on O2 and on the way to the ER, I can't see a reason why you shouldn't let them rest.


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## mycrofft (Jan 12, 2009)

*The "wanting to sleep" part may be the "Loss OC" part.*

Ease of arousal is then your key. "Keeping awake" is a layperson thing, assessing Level OC is the pro thing.


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## Shishkabob (Jan 12, 2009)

mikie said:


> So [not necessarily in an EMS patient-care scenario], but if you suspect someone with a head injury, the 'rumor' for going to sleep (being bad) is false?



That's what I was taught.


Also, the whole "peeing on a jellyfish things" hoo-hah too.

I was in Jamaica on a cruise last week and the bus driver to our SCUBA destination said if anyone gets stung, the 2 best things were vinegar (correct) and peeing on the sting, with the urine route being the better of the 2 in his words.


It took all my ability to not laugh at the guy and correct him, but I was on vacation.


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## traumateam1 (Jan 12, 2009)

If transporting to hospital: keep them awake to assess LOC, no point letting them sleep for 10 minutes then get waken up by ER staff to go thru the same procedures as you just did.

Standby: when I am doing event standby (extreme sports, other sporting events) than while under my care I keep them awake to assess them and ensure they truly don't need to go to the hospital (I always advise to seek further medical aid with a head injury that causes any loss of consciousness, or and decreased level of consciousness). If however they don't have DLOC or altered mental status then I let either a family member / spouse or whoever is gonna be taking care of them know that it is okay to let them sleep, but keep checking up on them ever 30 minutes - 1 hour. And then I give a list of symptoms to look for that requires a vist to the ER and a list of symptoms that requires an ambulance. Then I hand them a little pamphlet type thing explaining everything I just explained in case they forget anything or whatever.


I appologize for any gramatical errors, or if this just doesn't make sense.. I really haven't gotten much sleep in the last three days.


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## MSDeltaFlt (Jan 12, 2009)

It all depends on how accurately you can relay your findings and how reliably you can back them up.

If all you can say and prove is, ''Dude, he's bad off.'', then I would advise you to keep your pt awake.


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## chiefbo02 (Jan 12, 2009)

If it is  a long ride to the hospital and the MOI is not extreme I would let them rest. If there was loc and the pt is not alert an oriented then I would try to keep them awake.


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## BossyCow (Jan 12, 2009)

I've had patients nod off and you can't really tell if they are conscious when they are sleeping, so I keep asking them if they are okay. I've told some patients that if they nod off I'm going to assume they are unconscious and then the invasive stuff happens.. that usually wakes them up.


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## crotchitymedic1986 (Jan 12, 2009)

Answer this question:   How does keeping them awake, stop a concussion or a bleed ?   It does not.  When the patient is discharged from the ER, they will tell the family to wake the patient every 2-4 hours and assess their alertness.

The point of keeping them awake while in the ambulance is so that you can see a change for the worse.  So both answers are somewhat accurate.

If the patient just hit their head 10 minutes ago, and I have a 20 minute ride to the hospital, i will probably keep them awake, as I will be concerned that they do have a head injury if they are sleepy at 2 in the afternoon.

If I have a two hour ride to the trauma center, i will let them sleep awhile, and wake them intermittently.  If i am treating them in the ER, and they are stuck in the ER waiting on a bed for 8 hours, i would let them sleep, and wake them up every 1-2 hours for a quick check.

Nothing bad will happen while they are asleep that wouldnt happen while they were awake.


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## mikeylikesit (Jan 12, 2009)

I let them sleep when i'm done with my assessment. Most common misconception is that they will slip into a coma if you let them sleep.


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## BossyCow (Jan 12, 2009)

mikeylikesit said:


> I let them sleep when i'm done with my assessment. Most common misconception is that they will slip into a coma if you let them sleep.




But if they did, how would you know. I'd rather interrupt their nap than assume the unresponsive pt on my cot is 'just napping'. Besides, I'm such a scintillating conversationalist that my patients stay awake to hang on my every word


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## mikeylikesit (Jan 12, 2009)

BossyCow said:


> But if they did, how would you know. I'd rather interrupt their nap than assume the unresponsive pt on my cot is 'just napping'. Besides, I'm such a scintillating conversationalist that my patients stay awake to hang on my every word


 LOL, maybe they just want to sleep on me in order to ignore me....sigh...oh well.


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## ffemt8978 (Jan 12, 2009)

Some patients I WISH would go to sleep during the transport...


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## BossyCow (Jan 12, 2009)

crotchitymedic1986 said:


> Answer this question:   How does keeping them awake, stop a concussion or a bleed ?   It does not.  When the patient is discharged from the ER, they will tell the family to wake the patient every 2-4 hours and assess their alertness.
> 
> The point of keeping them awake while in the ambulance is so that you can see a change for the worse.  So both answers are somewhat accurate.
> 
> ...



It doesn't.. never said it did.. but if they are sleeping, you aren't really able to assess them are you?  Oh, that's right, you believe that we don't reallyh assess... we just fake it and dummy it into the report later.. My transport time is generally between 1/2 hour and 45 minutes.


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## triemal04 (Jan 12, 2009)

BossyCow said:


> It doesn't.. never said it did.. but if they are sleeping, you aren't really able to assess them are you?  Oh, that's right, you believe that we don't reallyh assess... we just fake it and dummy it into the report later.. My transport time is generally between 1/2 hour and 45 minutes.


Bossy...with a stable pt, how often do you check their blood pressure?  

I don't think anybody (especially with a long transport time) is saying let them sleep and ignore them, but if they doze off for awhile...so what?  Every once in awhile give them a nudge and see how they are doing.

Edit:  and try and ignore crotchity...this is the same tired crap that he's done elsewhere.  The topics he has may...sometimes...be good, but his presentaion and attitude..worthless.


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## jrm818 (Jan 12, 2009)

This isn't a stupid or obvious question at all.  The brain and the response to insult is very complex, and not totally understood.  Though the primary insult will not be effected, one of the most important theraputic targets in TBI is minimizing the secondary insult due to reactive inflammatory processes which follow injury.  I don't think anyone acutally knows what effects sleep would have on neurological outcome following TBI or ischemia or some form.  Sleep itself is ridiculously complex and not well understood at all.

I have a sneaking suspicion that sleep following some sort of insult would actually exert some sort of neuroprotective effects.  That's a guess based on other known tidbits: that certian anesthetics (barbituates mostly) are neuroprotective in TBI, although some are actually deleterious, that sleep is probably involved in all sorts of cell-level changes including the reorganization and maintainence of circuits, changes in cerebral blood flow and metabolism, possibly a bit of hypothermia (cerebral hyperthermia following TBI is usually found, and has been associated with poor outcome), and general maintenance of the CNS.  

There's not nearly enough understood to change clinical treatment at this point, but this is far from an obvious issue that can be easily dismissed.  The effect of TBI on sleep is fairly well characterized, the effect of sleep on TBI is not at all (that I could find).  I'd be very interested to see some study of the issue done...could also shed light on the mechanism by which anesthetics change neurological outcome.

Super question really...I'm quite intrigued.


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## daedalus (Jan 12, 2009)

ffemt8978 said:


> Some patients I WISH would go to sleep during the transport...



Thats why I have a bottle of Propofol in my pocket.


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## Hockey (Jan 13, 2009)

Alright maybe not a stupid question at all...

Interesting to see the various responses on this topic


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## marineman (Jan 13, 2009)

daedalus said:


> Thats why I have a bottle of Propofol in my pocket.



You call it propofol I call it Tequila but we're on the same wave length. I self administer mine though.


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