Sternal rub... who's doing it?

[OnceAnEMT]

I was taught coming out of school that, "based on evidence" (which I to this day have never seen), the sternal rub is being phased out because of lasting injury to the sternum from test after all receiving providers in the chain of care have done it. I don't see EMTs in my area do it, but I see nurses and docs do it in the ED all the time (you know, when indicated). So I'm curious, who still uses this in practice? Any arguments either way?

 

[Brandon O]

Meh. I pinch traps. A bit better diagnostically too.

 

[COmedic17]

I will do the sternal rub, pinch trap, squeeze finger nail, whatever is most convenient at the time.

 

[teedubbyaw]

Trap pinch works better IMO. Don't be afraid to clamp down on them.

 

[azbrewcrew]

Depends on the acuteness of their ETOH. If they are being toolbags they get a deep sternal massage

 

[DrParasite]

I've been told it is frowned upon, because it can aggravate a person who has a sternal injury.

Then again, I have been told that ammonia inhalants are being phased out of EMS too, yet they are common place in the ER.

Personally, I prefer a finger pinch than a sternal rub.

 

[teedubbyaw]

I've been told it is frowned upon, because it can aggravate a person who has a sternal injury.

Then again, I have been told that ammonia inhalants are being phased out of EMS too, yet they are common place in the ER.

Personally, I prefer a finger pinch than a sternal rub.

We carry ammonia [emoji3]

 

[STXmedic]

I prefer the trap squeeze or forceful rotation of the lateral pectoris (okay, it's basically a "titty twister"). Many people don't impart enough force on the sternal rub, and it's midline pain which can confuse localization with withdrawal. The finger pinch can utilize reflex arcs. The two former are both central, yet lateral of midline, and are very easy to create a painful response.

 

[DesertMedic66]

I prefer the trap squeeze or forceful rotation of the lateral pectoris (okay, it's basically a "titty twister"). Many people don't impart enough force on the sternal rub, and it's midline pain which can confuse localization with withdrawal. The finger pinch can utilize reflex arcs. The two former are both central, yet lateral of midline, and are very easy to create a painful response.

"Patient had a withdraw of pain from a titty twister, a purple nurple was preformed to confirm findings"

 

[LACoGurneyjockey]

Next time I do painful stimuli I'm going with the forceful rotation of the lateral pectoris
But around here sternal rubs are pretty much the standard painful stimuli

 

[OnceAnEMT]

Personally I am a trap pinch kind of guy. If I think (usually know based on hx from PD or Fire) the Pt is faking I put their hand up over their face and release. I have never seen someone fake their way out of that beauty.

Ah ammonia salts. I have seen them used once in the ED, per doc request when a sternal rub (which made its way to sternal punch) failed. I was surprised when someone actually knew they existed and gof them. It worked, too. First time I have seen it first hand.

@azbrewcrew , hopefully joking about patient abuse is just funny to you, and not something you practice.

 

[azbrewcrew]

Yes it was a satirical comment. Just coming off a 24 full of nothing but drunks and psychs. I take my duties as a clinician seriously

 

[NomadicMedic]

Yep. Trap squeeze is my go to. I saw a guy's chest in the ED the day after a narcotics OD and few sternal rubs from the first responders. He was pretty torn up.

 

[Brandon O]

The only caveat to the "Vulcan nerve pinch" is that it's not intrinsically the most noxious stimulus, so you do need to give it some good force, and if someone doesn't respond consider confirming with other maneuvers. I've been embarrassed to think a patient was totally unresponsive and have them wake up when they were moved to the ED bed or a medic gave them a pink belly or something.

 

[Kevinf]

I've watched yelling, sternal rubs, trap pinch, lobe pinch, and nail pinch all fail on a patient who was in fact... sleeping. That's a heavy sleeper right there, he had two EMTs, an RN, and a Doc all sweating

One of my partners has scars on her chest from where a medic did a sternal rub with his ring on years ago. I'm pretty sure she said he managed to break something as well. She's still pissed at him. So I'm not a fan of the sternal rub. Stick to soft tissue.

 

[RebelAngel]

We don't do smelling salts. We do sternum rub for painful stimulus or hand drop test if we think patient may be faking. For babies we flick bottom of feet.

 

[RedAirplane]

One stimulus that I was taught was: put a pen between the index and middle fingers (perpendicular to the fingers) then force the fingers together.

 

[LACoGurneyjockey]

We don't do smelling salts. We do sternum rub for painful stimulus or hand drop test if we think patient may be faking. For babies we flick bottom of feet.

Any reason more places aren't using ammonia inhalants? They work like a charm provided you're not being a **** about it.

 

[Brandon O]

Any reason more places aren't using ammonia inhalants? They work like a charm provided you're not being a **** about it.

They've been associated with harm. Plus a lot of people were being ****s about it.

 

[TrueNorthMedic]

I do the trap pinch. I think it's the most effective, plus when there's bystanders around, a trap pinch can be done many times without them (bystanders) knowing what you are doing. Versus grinding away on some guys chest with your knuckles.