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.
I've seen it. 97y/o female. Brand new EMT-b did a sternal rub and caused a massive skin tear on her chest. Thin skin and bad technique don't mix. Not the method I would have personally gone with, but as a phlebotomist I was not in a position to say anything. The medic, the nurse, and the doctor all took care of that though.
I've seen it too. I've also fired someone for being excessively forceful in regards to sternal rubs and overzealous in choosing when to use them. The straw that broke the camel's back on this was a little old lady (family friend of mine actually) who ended up with a large skin tear and associated bruising and bleeding. The EMT in question had to be escorted out of my office by the police.
has anyone tried the "drop test" where you pick up there arm and drop it on there face. If it falls to the side they are faking it, if it falls smack on there face they arent. Heard about it from an emt who goes to a lot of prison calls.
has anyone tried the "drop test" where you pick up there arm and drop it on there face. If it falls to the side they are faking it, if it falls smack on there face they arent. Heard about it from an emt who goes to a lot of prison calls.
I figured as much. I was just curious if anyone else was actually doing that cuz it sounded like a lawsuit in the making.
"Woh, what happened, I passed out... why is my lip busted open?"
agreed. i've also seen pts playing the system who are able to pass the arm drop test with flying colors. not reliable - there are much more reliable ways to test for playing the system....
Who wants to hear what the new guy has to say? Hahaha...
The trap squeeze has been called into question in many areas due to the risk of damaging the brachial plexus
Sternal rubs when performed PROPERLY are still acceptable in most areas (to my knowledge)
The pen between the fingers is a bad idea, a couple years ago some medics tried it on an elderly female with osteoperosis, had a lil' trouble explaining why the diabetic came in with fractured fingers
Pen + Fingernail on the other hand (hah! Get it? ) works quite well in my experience, but once again when performed PROPERLY. You don't have to smash the poor patient's finger in half with it.
Sidenote...the hand drop technique will indeed prove "fakers"...but when that patient is wearing a big heavy watch and you're a brand new EMT...I wouldn't advise it
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?
In Pennsylvania, NPA's are not indicated for use on a trauma patient, e.g. post-MVA. In this case if there was a question about airway, I would have used an OPA simply out of concern for the potential head trauma. Since the patient was A&O and would obviously have a gag reflex, airways are out anyway.
As for sternal rubs, same thing, what kind of trauma could be irritated from doing one? For one, you can take a piece of broken rib and push it into the lung causing a very bad situation very fast, or what if there is a AAA? Then it ruptures and again in a very bad situation.
Being that the BP dropped I would have been thinking shock, possibly that the patient was decompensating on me. I also didn't see any mention of O2 use which would have been my first precaution because of the many "what if's" that were unaccounted for any may not even be recognized until the patient is at the ER getting further diagnostic testing. I also would have been doing a secondary on the ambulance checking for bruising to exclude hypovolemic shock.
Being that the patient did "wake up" still wouldn't convince me that the patient was in the clear when it comes to shock because of the quick jolt of adrenaline that the patient would have had secondary to the pain from the sternal rub especially if there were other injuries involved that were yet to be diagnosed. Vasovagal stimulation is one possibility but there are several more things to rule out the way this newbie sees it
As for sternal rubs, same thing, what kind of trauma could be irritated from doing one? For one, you can take a piece of broken rib and push it into the lung causing a very bad situation very fast, or what if there is a AAA? Then it ruptures and again in a very bad situation.
Unless you're mongo fireman weighing down on that sternum like you're doing CPR I really doubt there is a chance of pushing a broken rib into a lung lol, and an AAA? Abdominal Aortic Aneurysm? Maybe a TAA Even then you'd have to be whompin' on that chest
As someone else mentioned, a sternum rub is designed to cause irritation, so if you're applying enough pressure to depress the chest you're doing it waaaay too hard
) works quite well in my experience, but once again when performed PROPERLY. You don't have to smash the poor patient's finger in half with it.
Even then you'd have to be whompin' on that chest