No more sternal rubs??

Jon

Administrator
Community Leader
7,989
48
48
..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...
Ok... First, it's "Chief" (I before E except after C, etc, etc), and "Rhythm".

Secondly - Lets talk commotio cordis. Are you familar with the term? What does it mean? What is involved in "knocking a heart out of rhythm"???
 

NUEMT

Forum Lieutenant
210
29
28
'A little research into the topic showed that patients who presented with ALOC had been sternal rubbed (SR'd) once by medics, then by nursing staff...again by docs.. then by every resident and or medic student in the ed..... and so on.. repeated rubs caused trauma.....this equals bad pt care. Uhh... do no harm. Even little harm.

I myself use it solely on possible arrests.

I would also say that I am trying to do away with and resist any notions (even joking ones) of punitive medicine. It's not what I practice and it's not tolerated around my patients. I always think to myself, "if that was my family, would I be ok with this?"
 

coolidge

Forum Crew Member
59
0
6
What is the difference between doing a sternal rub vs a trapezius squeeze in what they are measuring? Thanks
 

ExpatMedic0

MS, NRP
2,172
207
63
Some how this has slipped by me, I've never been told to avoid a sternum rub expect for the obvious contraindications. Is there any recent evidence base for suggesting its no longer appropriate for clinical practice? Is there an actual professional medical body who condemns the practice ? Everyone's entitled to their anecdotal evidence and opinions on why alternative methods maybe preferred...I am just curious
 

Remi

Forum Deputy Chief
Premium Member
3,791
2,424
113
Some how this has slipped by me, I've never been told to avoid a sternum rub expect for the obvious contraindications. Is there any recent evidence base for suggesting its no longer appropriate for clinical practice? Is there an actual professional medical body who condemns the practice ? Everyone's entitled to their anecdotal evidence and opinions on why alternative methods maybe preferred...I am just curious
Good questions.
 

ExpatMedic0

MS, NRP
2,172
207
63
I regularly use it, Iv'e never been questioned by other medics or ED staff and I have never read any literature stating it should be avoided (aside from obvious contraindications) . I was actually really surprised to see this thread and many of the replies. "Different strokes (or painful stimuli) for different folks" I suppose.
 

zzyzx

Forum Captain
428
90
28
Personally, I use sternal rubs. That said, a known downside of sternal rubs is that you have to do the sternal rub for a significant of time before some people will respond.
 

Fry14MN

Security Officer/Dispatcher/FR
151
103
43
....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...
I wear a ring on my left hand(not ring finger). I'm left handed so I use my left had for a sternal rub and I've never had it get in the way but its also flat. I could maybe see if he or she has some huge blingin' rock of some kind but if it's that big I would think that would be removed before shift. And not to mention using gloves would be a hassle.
 

Melbourne MICA

Forum Captain
362
10
18
For RobertAlfanoNJEMT: The sternal rub is abused by everyone from my observations. It was never intended as a means to wake patients. In fact, pain stimulus applied to the sternum as part of the Glasgow coma score assessment NEVER in fact, included a full handed knuckle rub. The idea in the GCS is application of a painful stimulus to the sternum should illicit a response from the patient to reach across and remove the stimulus. This indicated a higher or lower level of brain function. This makes complete sense when you consider the next part of the assessment is to determine if the response (or level of functioning brain activity) is unilateral perhaps suggesting stroke as a differential cause of the unconsciousness. You can see that if, with each test, as they get more and more narrowly defined, there is still no response then the level of unconsciousness is worse and expressed by the falling GCS score. The stimulus itself is commonly defined as equivalent to the tip of a pen applied firmly to the sternum. Application of anything more than a pen tip level of pain is both unethical and clinically misleading because it gives an overestimate of conscious state in terms of the GCS by rousing the patient from what may well be deep unconscious due to a serious neuro event. In particular, over stimulus may have ramifications in causing a pain induced rise in HR, BP, M.A.P. and subsequently I.C.P. - a really undesirable thing to do if the cause of unconsciousness is a cerebral bleed. The classic example of this explanation is an event I witnessed involving a a stream of nurses who 1 by 1, attended a young unconscious male in the Ed brought in by paramedics who probably did the same thing, assumed a drug overdose, and applied brutal sternal rubs one after the other in order to wake him up - reason being if they couldn't, under ED policy (of which I was aware having visited this ED many times), he would need to go to ICU and obviously take up a bed. The prejudiced, judgmental and basis of this approach to patient care (I actually interceded and complained at the time as I was writing up my paperwork nearby) was completely rendered a farce when it was discovered he in fact had a neuro-bleed not a drug overdose. I really don't think I've seen a better example of the whole knuckle rub abuse scenario. Perhaps that's why its been withdrawn by so many services or maybe some EMT's have been sued? I hate anecdotal orthodoxies and Ambos are so willing to adopt them it seems. Piss poor practice and no benefit to patients if you ask me.
 

RobertAlfanoNJEMT

Forum Lieutenant
105
4
18
For RobertAlfanoNJEMT: The sternal rub is abused by everyone from my observations. It was never intended as a means to wake patients. In fact, pain stimulus applied to the sternum as part of the Glasgow coma score assessment NEVER in fact, included a full handed knuckle rub. The idea in the GCS is application of a painful stimulus to the sternum should illicit a response from the patient to reach across and remove the stimulus. This indicated a higher or lower level of brain function. This makes complete sense when you consider the next part of the assessment is to determine if the response (or level of functioning brain activity) is unilateral perhaps suggesting stroke as a differential cause of the unconsciousness. You can see that if, with each test, as they get more and more narrowly defined, there is still no response then the level of unconsciousness is worse and expressed by the falling GCS score. The stimulus itself is commonly defined as equivalent to the tip of a pen applied firmly to the sternum. Application of anything more than a pen tip level of pain is both unethical and clinically misleading because it gives an overestimate of conscious state in terms of the GCS by rousing the patient from what may well be deep unconscious due to a serious neuro event. In particular, over stimulus may have ramifications in causing a pain induced rise in HR, BP, M.A.P. and subsequently I.C.P. - a really undesirable thing to do if the cause of unconsciousness is a cerebral bleed. The classic example of this explanation is an event I witnessed involving a a stream of nurses who 1 by 1, attended a young unconscious male in the Ed brought in by paramedics who probably did the same thing, assumed a drug overdose, and applied brutal sternal rubs one after the other in order to wake him up - reason being if they couldn't, under ED policy (of which I was aware having visited this ED many times), he would need to go to ICU and obviously take up a bed. The prejudiced, judgmental and basis of this approach to patient care (I actually interceded and complained at the time as I was writing up my paperwork nearby) was completely rendered a farce when it was discovered he in fact had a neuro-bleed not a drug overdose. I really don't think I've seen a better example of the whole knuckle rub abuse scenario. Perhaps that's why its been withdrawn by so many services or maybe some EMT's have been sued? I hate anecdotal orthodoxies and Ambos are so willing to adopt them it seems. Piss poor practice and no benefit to patients if you ask me.
I can agree with most of what you are saying and you actually gave a solid explanation and reason so thank you!
 

Melbourne MICA

Forum Captain
362
10
18
I can agree with most of what you are saying and you actually gave a solid explanation and reason so thank you!
You're welcome. Good practice is so easily sidetracked by orthodoxies that catch on and develop a life of their own. They are rarely balanced, evidence based behaviors, rather a mob mentality. When combined with our prejudices and biases the end result is bad practice. Young guy unconscious becomes scum bag druggie who deserves all he gets..........What if he was a hard working honest white collar professional who just overdid it on this particular occasion.?
 

NoahW5394

Forum Probie
13
0
1
Just my 2 cents as a forum ride along

I first head of the sternal rub in cert training. Our instructor was a police officer and AHA first aid guru. He said that the manuvar had been banned for several years and was now considered assault.

I can see why it would be a go to, but simply as a trained civilian, I would never try this on a female. Would look like I had something other than her safety in mind...
 

akflightmedic

Forum Deputy Chief
3,297
1,728
113
I can see why it would be a go to, but simply as a trained civilian, I would never try this on a female. Would look like I had something other than her safety in mind...
If you think the sternal rub might be deemed inappropriate based on gender, then you are doing it wrong...very wrong. There is absolutely zero change of misinterpreting your intention of a sternal rub when done in the proper situation and performed properly.
 

NoahW5394

Forum Probie
13
0
1
If you think the sternal rub might be deemed inappropriate based on gender, then you are doing it wrong...very wrong. There is absolutely zero change of misinterpreting your intention of a sternal rub when done in the proper situation and performed properly.
Can you explain the proper way to do a sternal rub?
 

akflightmedic

Forum Deputy Chief
3,297
1,728
113
Knuckles to sternum with small circular motion....if you think someone is going to confuse you in uniform leaning over an unresponsive victim while rubbing their sternum with the sexual violation of a female, then either you are doing it wrong or need an anatomy lesson.
 

NoahW5394

Forum Probie
13
0
1
Knuckles to sternum with small circular motion....if you think someone is going to confuse you in uniform leaning over an unresponsive victim while rubbing their sternum with the sexual violation of a female, then either you are doing it wrong or need an anatomy lesson.
You may have mis understood, I have no uniform. But that aside, I do see your point, plus it's not like it would ever be done on a person who wasn't obviously unconcioius or near unconcioius. Thanks for the reply
 
Top