Friday, March 25, 2011

Medical Myth: Head Injured Patients Need to Stay Awake

I love the series Dexter. If you're unfamiliar with it and you're a writer, I think it's a great exercise in intricate plotting techniques. However, it is violent, so proceed with caution. The general premise is that Dexter works for Miami Police as a blood splatter specialist. In his free time, he's a serial killer, but only kills those that the justice system doesn't put away. This show is also good study for the sympathetic villain.

In one episode, poor Dexter has been in a motor vehicle collision. He is dazed and is taken to the ER. The doctor says something to the effect of, "You have a head injury. You'll need to stay awake for the next several hours." Great.

Sleepiness post head injury is a classic set-up for pediatrics. Every day in the ER is a story like this. It's close to bed time. The children are running amok. Some child falls down, falls into, or falls off of something and hits their head. They cry their little heart out. After all, hitting your head hurts, a lot. After a good crying bout, they're sleepy. Parents first thought is, he must have a terrible head injury. Off to the ER.

Now, one, I want to make it clear. Getting your child checked in the ER for head injury is good and reasonable. However, we aren't all that concerned with sleepiness. What we are concerned with is how arousable they are from sleep. This is what we'll be monitoring every fifteen minutes to an hour if the child sleeps during his ED visit.

Level of consciousness is assessed as an indicator of an injury going on inside of the head. How arousable you are is the most sensitive indicator of level of consciousness. If the child falls asleep, and we are concerned about head injury, we'll try to wake them up every so often to assess their level of arousability. If we cannot wake them up, then we are concerned. It has to be more than a gentle nudge. You are really working to wake the patient and they won't respond. This is concerning.

Remember, things that are injured need rest. This is why we put you on crutches if you break an ankle. The brain rests by sleeping. It helps it to heal. If you're a subscriber to this myth, how long should we keep the patient awake? An hour? Two hours? A day? If you want a skewed neuro exam, try doing one on a sleep deprived patient.

For additional resources regarding this myth, check out the following:



Did you believe this myth?


  1. Another myth debunked! Thanks for the reminder that just because I've heard something repeated a gajillion times does not mean it's true! :-)

  2. Thanks for your comment Ava. Any other common medical myths you can think of?

  3. Can't think of a myth off-hand, but I do have one question that I never seem to keep straight - not sure if you've covered this in a previous post...
    is there a general rule for using heat or ice for an injury?

  4. Ava, thanks for your question. Generally, for soft tissue injuries (sprained wrist/ankle) ice is encouraged the first 24-48 hours. Then, the patient may choose to use heat.

    The issue with heat is that it will increase blood flow to an area... so if the area is still greatly swollen with fluid, ice may be better even after the first two days.

    If more chronic pain post initial injury and there is no swelling, heat may be more preferential then.

    The doctor can provide good guidelines for the patient as well.