No more sternal rubs??

Remi

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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.
I think this is really over stating the "problem" with sternal rubs.

Certainly it can be abused. So can any other method of painful stimulation. And perhaps it isn't a useful component of a detailed neuro exam, but it is certainly convenient way to assess a general level of consciousness.

Why is it unethical to cause pain with a sternal rub, but not unethical to cause pain with a trap squeeze or a pen on the fingernail?
 
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DrParasite

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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 call BS on this statement. Can you provide any court cases where EMS personnel have been criminally charged for administering a sternal rub? Can you provide any judicial decision where a judge deemed a sternal rub to be equal to assaulting a person? How about a text book from AHA or one of the EMT publishers clearly stating that sternal rubs are no longer permitted?

If might be your instructors law enforcement opinion that a sternal rub should be considered assault, and I have heard they have fallen out of favor because you can cause harm if the person has a fx sternum, but I have never heard anything about them being banned and to administer one is considered assault.
 

DrParasite

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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.
I think the bigger issue there was if one person didn't succeed, the next in line did the exact same thing expecting different results.
 

RobertAlfanoNJEMT

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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.
To clearify the sternum is higher up, so when doing it your hand should not be in the woman's breasts, also you should not be lifting your hand when you do it so it won't look like you're rubbing her breast.. Plus who would assume you are doing that?? What kind of creep sees a female faint and automaticly runs over and feels up her breast
 

akflightmedic

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Not sure why you quoted me since I said essentially the same as you...
 

ERDoc

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What kind of creep sees a female faint and automaticly runs over and feels up her breast
You haven't been doing this job very long, have you?

I have to agree that multiple sternal rubs by multiple people is overboard and bordering on assault, but used properly it can be very helpful.
 

Handsome Robb

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I've never heard that sternal rubs had fallen out of favor.

I generally do a trap squeeze or if I think someone may have the potential to wake up and be angry and hostile towards me I'll use nail bed pressure with a pen so I'm not directly over the top of them.


Sent from my iPhone using Tapatalk
 

vc85

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I was told not to use eternal rubs because they are ineffective. Supposedly the nerves to that area don't go directly to the brain

They said to do a trap squeeze as the nerve runs directly to the brain
 

NomadicMedic

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I was told not to use eternal rubs because they are ineffective. Supposedly the nerves to that area don't go directly to the brain

They said to do a trap squeeze as the nerve runs directly to the brain
Yes. 100% true. The sternum is innvervated by the splenic nerve, which goes directly to the spleen, bypassing the brain entirely.

:)

It's worth looking at the types of painful stimuli you're using to determine responsiveness and WHY you're doing it. You really don't need to inflict a whole slew of painful stimuli to a simple unconscious person right off the bat.

Central stimulus, like a trap squeeze, sternal rub or my wife's favorite, supraorbital pressure, is a solid way to measure if a patient flexes or withdraws from pain. Peripheral stimuli (like nail bed pressure) may just trigger a reflex reaction.

If you're just trying to wake someone up, an intoxicated person, for example... A shake and a loud "HEY!" usually does the trick.
 

NomadicMedic

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Well, how many times have you seen an EMT or a first responder put in the knuckles to somebody who's just passed out after drinking?

:)
 

Remi

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I was told not to use eternal rubs because they are ineffective. Supposedly the nerves to that area don't go directly to the brain

They said to do a trap squeeze as the nerve runs directly to the brain
And this is why not taking anatomy seriously is a problem.
 

vc85

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Hey don't shoot the messenger :)

This is what one of our agencies training officers said was told to him by an MD at a major EMS conference.

Now, putting on my computer science hat for a minute, it is a shorter distance from the brain to the trap than to the sternum so propagation delay is reduced. Not that it would make any difference in a ems setting. But maybe that is what the doctor was getting at?
 

Flying

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Now, putting on my computer science hat for a minute, it is a shorter distance from the brain to the trap than to the sternum so propagation delay is reduced. Not that it would make any difference in a ems setting. But maybe that is what the doctor was getting at?
Peripheral vs central nervous system. Stimulating different parts of the anatomy will have varying effects because there are multiple incoming (afferent) pathways, each of which terminate differently.
 
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