Sasha
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A couple good articles on sternal rubs and painful stimulus. I know a lot of people don't like sternal rubs, and I know I generally don't do a sternal rub for 30 seconds.
Misinterpreting the Results of a Sternal Rub
Full Article: http://www.ems1.com/ems-products/ed...Misinterpreting-the-Results-of-a-Sternal-Rub/
Interpreting a Peripheral Painful Stimulus Response
Full Article: http://www.ems1.com/ems-products/ed...eting-a-Peripheral-Painful-Stimulus-Response/
Misinterpreting the Results of a Sternal Rub
Full Article: http://www.ems1.com/ems-products/ed...Misinterpreting-the-Results-of-a-Sternal-Rub/
When assessing a patient who is not alert and does not respond to verbal stimuli, a painful stimulus may be applied to the body. The sternal rub is the most common stimulus practiced out in the field. However, it is possible to misinterpret the patient’s response to the stimuli depending on the duration the pressure is applied.
Response to the stimulus is used to make assumptions about the integrity of the brain and its function. If the patient responds to the pain with what is interpreted as purposeful movement, it is assumed that the brain received the impulse, was able to interpret it, and responded with some degree of a correct response.
If the patient does not respond, it is assumed the brain either did not receive the impulse or was unable to interpret the stimulus. If the brain is unable to interpret the painful stimulus and send out a correct response, one would think that its integrity is compromised and the patient is at grave risk for losing vital functions. Thus, a patient who does not respond to a painful stimulus would be thought to be critically ill or injured.
Interpreting a Peripheral Painful Stimulus Response
Full Article: http://www.ems1.com/ems-products/ed...eting-a-Peripheral-Painful-Stimulus-Response/
Emergency medical service personnel often work under conditions that can be best described as “extremely uncontrolled.” Under these conditions, patient assessment is expected to be conducted in a rapid manner, in order to collect as much history and physical exam information as possible.
This information is used during the critical thinking process to develop a differential field diagnosis. Further assessment and emergency care is based on the differential field diagnosis; thus, the information collected must be as accurate as possible. Inaccurate information can lead to improper care. However, the results of the exam may not always provide the most accurate information.
Last month’s column discussed the possible misinterpretation of a sternal rub response in a patient with an altered mental status. In addition to the sternal rub, there are a few other situations where the results from a physical exam conducted on a patient with an altered mental status may be misinterpreted.