Forum Deputy Chief
I think this is really over stating the "problem" with sternal rubs.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.
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?