No more sternal rubs??

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RobertAlfanoNJEMT

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Apparently according to my crew chief/assistant Cheif we are no longer allowed to perform sternal rubs as a painful stimuli. He tried to explain to me why we cannot but it still didn't make sense. I'm not sure if this is something from our medical director or a new state protocol, but nonetheless if someone could explain why it is not recommended I'd appreciate it.
 
Its been phased out in my area now for around 4 years. We still have plenty of people doing it however. I believe it had to do with some patients (trauma) possibly having a Fx sternum and it may also look inappropriate if you are doing it to a female patient.
 
The programs I taught for and in practice at the services I worked for, we had discontinued the sternum rub as far back as early 2000s. Was surprised to see this thread actually.

There are far better ways to assess painful stimuli than a sternum rub. Additionally, it was an abused practice as well, yes whether you admit or not, there are several sick folk among us who get off on inflicting pain to drunks, ODs, and fakers. And the rub does not need to be repeated, yet it often is...draw your own conclusions.
 
MrJones said:
Meh. Take the barrel of your pen and squeeze it hard against the patient's thumbnail. Guaranteed to wake the dead. Well, not quite, but you get the idea.
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You can get activation of reflex arcs with peripheral pain stimulus. If you're just trying to wake them up, then no big deal. But if you're trying to truly assess neuro status, then reflex arcs can throw off your assessment.
 
STXmedic said:
You can get activation of reflex arcs with peripheral pain stimulus. If you're just trying to wake them up, then no big deal. But if you're trying to truly assess neuro status, then reflex arcs can throw off your assessment.
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Possibly so, but not in my experience....
 
MrJones said:
Possibly so, but not in my experience....
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Oh? You get definitive neuro findings on all your patients that you perform painful stimulus on? That's impressive, especially considering the vast majority of paramedics can't even name the cranial nerves. When an unconscious patient withdrawals from your peripheral pain infliction, what finding do you look for that tells you it's not a reflex?
 
Pinch their trap and put ammonia salt under their nose.


It's my go-to for when drunks won't wake up.
 
STXmedic said:
Oh? You get definitive neuro findings on all your patients that you perform painful stimulus on? That's impressive, especially considering the vast majority of paramedics can't even name the cranial nerves. When an unconscious patient withdrawals from your peripheral pain infliction, what finding do you look for that tells you it's not a reflex?
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Public Service Announcement: If you would like to discuss a topic - especially a point of disagreement - with me it is important to do so calmly, respectfully and without obvious snark or sarcasm. Why, you ask? Because responses such as the one quoted here are destined to go unanswered.

;)
 
I have removed one post from this thread. Keep this discussion civil or this thread will be closed and offenders may end up taking a break for a while. There's at least one or more other posts here that are bordering on the edge of civility but remain because they still contribute to the discussion, for now.
 
MrJones said:
Public Service Announcement: If you would like to discuss a topic - especially a point of disagreement - with me it is important to do so calmly, respectfully and without obvious snark or sarcasm. Why, you ask? Because responses such as the one quoted here are destined to go unanswered.

;)
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Is this a fancy way to say " I don't know how to answer that question, so I will just refuse to answer it..."?
 
Akulahawk said:
I have removed one post from this thread. Keep this discussion civil or this thread will be closed and offenders may end up taking a break for a while. There's at least one or more other posts here that are bordering on the edge of civility but remain because they still contribute to the discussion, for now.
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Aww, I thought it was actually quite reserved... :p
 
STXmedic said:
Aww, I thought it was actually quite reserved... :p
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While this particular post is civil in tone, keep the discussion on topic. It would really not be good for discussion if this thread were placed on moderation because of posts like this that do not further the discussion.
 
I will still use a sternal rub, but I am gentle about it - I actually use my fingertips instead of my knuckles.

Most people find it extremely noxious even with considerably less pressure than what it typically takes to cause a bruise. The only time it causes problems is when people do it really hard, or over and over.
 
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I had both a classmate and a coworker that have scars from when they got a sternal rub when the rubber didn't remove their ring. Both of them women and neither happy about the scars on their chests. I stick with a trap pinch myself.
 
Kevinf said:
I had both a classmate and a coworker that have scars from when they got a sternal rub when the rubber didn't remove their ring. Both of them women and neither happy about the scars on their chests. I stick with a trap pinch myself.
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....I'm just trying to imagine in my mind how it would be possible for a ring to get in the way while doing a sternal rub... Since a ring def wouldn't be on the knuckles used..... And if it was, I wouldn't think you would be able to bend your finger all the way...
 
akflightmedic said:
The programs I taught for and in practice at the services I worked for, we had discontinued the sternum rub as far back as early 2000s. Was surprised to see this thread actually.

There are far better ways to assess painful stimuli than a sternum rub. Additionally, it was an abused practice as well, yes whether you admit or not, there are several sick folk among us who get off on inflicting pain to drunks, ODs, and fakers. And the rub does not need to be repeated, yet it often is...draw your own conclusions.
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I used it for example on a paralyzed pt found at a bar who'd helped himself to a nice cocktail of mixed opioids and alcohol. I knew we were no longer supposed to do it but I couldn't exactly deliver painful stimuli to his lower extremities, plus it was working he'd come awake enough to speak to me for a few seconds when I'd do it.. I think my crew Cheif was inferring that sternal rubs can cause some cardiac issues which I don't really understand how, unless you are doing it so hard that you knock the heart out of rythem. Nonetheless when we got in the back there was no need to continue sternal rubs because when the paramedics started a 20 gauge IV he was awake and screaming like they had dug a knife into his arm! He may have had some nerve damage from his accident, but I have never seen someone respond so verbally to an IV. He screamed right in my ear all the way to the ER
 
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