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Is there any medical value when a care provider talks to a trauma patient to keep the patient conscious?

It's well known that in cases of trauma (in physical medicine) always the paramedic or physician would try to talk to the patient in order to keep him or her conscious. It's known also from movies as the sentence "Stay with me, man!" etc.

Is there any medical value to do that? While it doesn't seem to matter to talk someone that lost a lot of blood, if the patient will lose consciousness, they will lose it with or without conversation. The only medical value that I can think about, is just to observe and monitor the patient but not as a tool to keep them conscious. Is that right?

I would like to see any scientific reference that supports the claim that it helps actively to keep the patient conscious, if any.

  • Medical value? More than likely...since it stimulates the patient, albeit not as vigorously as a sternal rub or poking them with a needle. – user7622 Dec 10 '16 at 21:08
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Just because there may exist some patients who are going to lose consciousness (or die) no matter what doesn't mean this technique has no value.

Imagine this. It's the middle of the night. You're in awful pain. Something horrible and unexpected has happened - a car accident, a crime, a house explosion - and you've seen awful things or you're worried about your loved ones on top of everything else. You don't want this to be real. You don't want to experience this. Going away, by zoning out, letting yourself fall asleep, co-operating with the pull you feel towards unconsciousness - that may seem like a good idea. A person telling you not to may actually keep you from letting go and going under, because some part of it is your choice whether to stay conscious or not, at least for some kinds of injury or trauma.

As to why a care provider wants to keep you awake, it's generally so they can ask you things, or get you to help them treat you. This was my experience when a 3am gallbladder attack took me to the ER. It hurt so much and I was so tired and this nurse was all in my face, demanding I categorize my pain "on a scale of 1 to 10" which I find pointless since they never ask you what a 10 would be, and she wouldn't take no for an answer so I basically closed my eyes and wished she would go away, and I would have happily gone to sleep right there, or at my pain level you could have called it passing out from the pain. But she wouldn't let me. She was firm to the point of rudeness and she was demanding. Her position was "I need you to talk to me so I can help you." And in the end I did and she did.

The point is there is much use to the patient staying conscious - it lets you see if things are getting worse or better, lets you gather information, lets you ask them to roll over or sit up - and in at least some cases, asking (along perhaps with slapping as in the movies, shoulder-shaking, or at least physical contact like taking someone's chin and using it to turn their face towards you) does work to keep people from slipping away.

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No, I don't think keeping a patient awake has any treatment value in trauma cases. I'm skeptical there even are situations where you could override the effects of traumatic injury by simply talking.

However, it has significant value in assessment. Level of consciousness is the first and most significant vital sign, and being able to monitor it in trauma is crucial. Declines in many body systems will be signaled by the brain first, so you always want to be aware of the patient's mental status. You do that by talking to them.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4129809/

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    Furthermore, someone who is conscious can become unconscious. Especially with brain damage, when the patient collapses and looses consciousness, it’s a good indicator something is wrong. Sleeping patients can’t tell you if the situation deteriorates.... – Narusan Nov 21 '17 at 5:59
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This is certainly an interesting question. From a trauma perspective, I would advocate using the ATLS / ACLS rules to stabilize the patient. Controlling the airway, breathing, and circulation are the first priorities in these patients.

With that said, there is not much published on PubMed that answers this question. However, I did find an article in Nursing Times that talks about some value in talking to patients - whether they are conscious or unconscious. This has been shown to improve survival in a very limited sample. However, I would caution using this as "evidence-based" literature and would always focus on the ABCs.

Here is the article: Nursing Times

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