Something Weird

Fox800 said:
Then you probably should have pulled it at the first sign of your patient not tolerating it.

Might I suggest an NPA w/lidocaine surgical jelly before an OPA, if you think your pt. might be "lightly" unconscious or faking, as opposed to jumping straight to an OPA?

It's uncanny how well it works.
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I think you misunderstood what i meant. My point was to assess corneal reflex before attempting an OPA. Corneal reflex (-) pt should accept an OPA.
 
8jimi8 said:
please do not brutalize your patients. use a trap squeeze.
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since when does squeezing someone wake up a faker? unless you are pinching, which leaves bruises....whereas the pen trick (from medic class - also can take the pen and push it against the base of the pts fingernail and "scrape" it off the finger) does not leave bruises and you don't have to apply very much pressure at all, to illicit any type of response if you are going to get one......i didn't realize that was considered brutalizing a pt.
 
PrincessAnika said:
since when does squeezing someone wake up a faker? unless you are pinching, which leaves bruises....whereas the pen trick (from medic class - also can take the pen and push it against the base of the pts fingernail and "scrape" it off the finger) does not leave bruises and you don't have to apply very much pressure at all, to illicit any type of response if you are going to get one......i didn't realize that was considered brutalizing a pt.
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pushing something hard against a small bone is a great way to break it. Have you ever had anyone squeeze your trap? There is no way someone can fake through it. Do a corneal reflex, again there is no way that someone can extinguish their involuntary response. You won't break any bones doing a trap squeeze or corneal reflex. The first time you break someone's finger, or pull their nail off, will be when you believe me? :)
 
PrincessAnika said:
since when does squeezing someone wake up a faker? unless you are pinching, which leaves bruises....whereas the pen trick (from medic class - also can take the pen and push it against the base of the pts fingernail and "scrape" it off the finger) does not leave bruises and you don't have to apply very much pressure at all, to illicit any type of response if you are going to get one......i didn't realize that was considered brutalizing a pt.
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It's not brutalizing, unless you're doing it wayyyyyyyyy wrong. I learned the pen trick from my first partner, one of the best paramedics I know, been working for 20+ years.
 
8jimi8 said:
pushing something hard against a small bone is a great way to break it. Have you ever had anyone squeeze your trap? There is no way someone can fake through it. Do a corneal reflex, again there is no way that someone can extinguish their involuntary response. You won't break any bones doing a trap squeeze or corneal reflex. The first time you break someone's finger, or pull their nail off, will be when you believe me? :)
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i never said push HARD.....and anyone squeezes any muscle on me i bruise - i thought the object was not to leave marks? i know i'm not the only one who bruises easily....to clarify, i get so much as poked in the arm and i bruise...lol
 
Fox800 said:
It's not brutalizing, unless you're doing it wayyyyyyyyy wrong. I learned the pen trick from my first partner, one of the best paramedics I know, been working for 20+ years.
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Sorry i watched a neurologist doing it... the patient didn't respond, so he did it harder... then harder... I was like... dude... let the propofol wear off. The patient had blood blisters under her nails when he was done.

Sometimes you see one example and then extrapolate it to everyone. My bad! Please accept my apologies. I haven't taken a class that has taught me about that technique yet and my only example was that neurologist... brutalizing the poor patient.
 
8jimi8 said:
Sorry i watched a neurologist doing it... the patient didn't respond, so he did it harder... then harder... I was like... dude... let the propofol wear off. The patient had blood blisters under her nails when he was done.

Sometimes you see one example and then extrapolate it to everyone. My bad! Please accept my apologies. I haven't taken a class that has taught me about that technique yet and my only example was that neurologist... brutalizing the poor patient.
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Damn...you'd have to be doing it HARD to make that happen.
 
Fox800 said:
Also, don't do sternal rubs. Ever. Unless you like being sued.

Pinching the trapezius, or a properly applied ammonia inhalant works wonders. Notice I said PROPERLY.
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I was also taught not to do a sternal rub.
 
Sandog said:
I was also taught not to do a sternal rub.
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There are varying degrees of Bad Idea. You might be able to get away with doing a sternal rub on a 20 year old male passed out drunk, doing a sternal on a 70 year old woman in a nursing facility who is genuinely comatose (and on warfarin, which you hadn't asked about yet) is a Very Bad Idea Indeed(TM).
 
Fox800 said:
There are varying degrees of Bad Idea. You might be able to get away with doing a sternal rub on a 20 year old male passed out drunk, doing a sternal on a 70 year old woman in a nursing facility who is genuinely comatose (and on warfarin, which you hadn't asked about yet) is a Very Bad Idea Indeed(TM).
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You have my full attention.
 
Sandog said:
You have my full attention.
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Just throwing out a hypothetical. This hasn't happened in my presence, but I'm sure it easily could, and has happened somewhere out there. I'd like to witness hospital staff biting off the heads of an EMS crew who brings in a pt. with a bruised sternum.
 
Fox800 said:
Just throwing out a hypothetical. This hasn't happened in my presence, but I'm sure it easily could, and has happened somewhere out there. I'd like to witness hospital staff biting off the heads of an EMS crew who brings in a pt. with a bruised sternum.
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Agreed, Taking AVPU one step too far is not a good idea :) I opt for less evasive methods.
 
Funny, In 20 years I have yet to bruise a sternum or break a rib. Biggest thing is no one is ever taught how to do it correctly. You do not need to actually rub the sternum, all that you need to do it roll your knuckles on it. it is painful and does not do any damage.

There are many methods to test response and all can be bad, if done wrong. Learn the right ways and not injure the Pt's.
 
Reaper, you got a job, pull that tongue back in...:)
 
Reaper, you know that was a joke, right?
 
I'm not sure corneal reflex is the best thing to test, nor reflexes in general. You are looking for where the person is on AVPU and trying to get their GCS (and maybe wake them up). Someone can be in a coma and various reflexes are intact. If someone said the patient was responsive to pain based on a corneal reflex I would argue that all they have shown is that a corneal reflex is intact. Trap pinch is useful for seeing if the patient is faking or can be aroused, but one nice thing about more peripheral stimuli like the fingernail is that you can distinguish between withdrawing to pain and localizing to pain. Again, not a super important distinction pre hospital but nice to keep track of in the Unit.
 
8jimi8 said:
Sorry i watched a neurologist doing it... the patient didn't respond, so he did it harder... then harder... I was like... dude... let the propofol wear off. The patient had blood blisters under her nails when he was done.

Sometimes you see one example and then extrapolate it to everyone. My bad! Please accept my apologies. I haven't taken a class that has taught me about that technique yet and my only example was that neurologist... brutalizing the poor patient.
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ah well then yeah i can see that. you dont have to do it hard for it to test or pain response tho. take one fonger and press on another one on yourself, then slide the pressing finger off the nail -- thats all the pressure you need to do it properly. if it doesnt work try once more but you dont keep going over and over again....that neuro should have to have that done to HIM. idiot.
 
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