Sternal rub... who's doing it?

The day you do a hand drop test on a legit unconscious patient and break their nose, you'll stop that nonsense.
 
Ishan said:
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.
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Please tell me you're joking, or at least don't practice that in the field...Painful, sure, but if I see someone wasting there time doing that I would call them out on it
 
DEmedic said:
The day you do a hand drop test on a legit unconscious patient and break their nose, you'll stop that nonsense.
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:P Probably true, but I'm not saying use it as a replacement to sternal rub or trap pinch, I'm saying use it when its already clear the patient is malingering in order to be able to say "Gotcha. Now stop playing games."

I've heard of the pen between the fingers. Read somewhere that it is too peripheral to assert the appropriate pain response, but I didn't quite get that. Trap pinch requires less resources (read: pen), so there is my go-to.
 
I think a bit much has been made in the past of the hand-drop, although it can unquestionably be abused. Certainly though it should only be done with your other hand over the face to catch if it turns out to be positive.
 
Ishan said:
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.
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This is one of the only two officially approved methods for testing painful stimulus response in my county. The other is the fingerbed nail pinch. I've pretty much always used the latter as it's simply, well, simpler lol (and easier to do, just grab and pinch)

DEmedic said:
The day you do a hand drop test on a legit unconscious patient and break their nose, you'll stop that nonsense.
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Though I have seen someone do this method once before...and their hand landed smack right on their (the patient's) face. D'oh.
 
Here's the thing, why do you care if they're pretending?

If they want to fake unconsciousness, more power to them.

Vital good, all diagnostics negative, but you "think" they're faking? Leave em alone. It's a more mellow ambulance ride for you. :)
 
DEmedic said:
Here's the thing, why do you care if they're pretending?

If they want to fake unconsciousness, more power to them.

Vital good, all diagnostics negative, but you "think" they're faking? Leave em alone. It's a more mellow ambulance ride for you. :)
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Pretty sure I've had that patient at 108. Several times.
 
I do sternal rubs but I use the pads of my fingers instead of my knuckles.
 
It depends on the situation but I've used sternal rub, trap pinch, hand drop test and another one.

Whatever is most appropriate and convenient is usually what gets done. We are another place that doesn't use ammonia tabs but the ER does.
 
DEmedic said:
Here's the thing, why do you care if they're pretending?

If they want to fake unconsciousness, more power to them.

Vital good, all diagnostics negative, but you "think" they're faking? Leave em alone. It's a more mellow ambulance ride for you. :)
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My thoughts exactly.

You want to fake unconsciousness? Sweet deal. Means I can sit back and do my paperwork. Always nice being finished with your PCR by the time you arrive at the ER minus inputting the MR number, room number and receiving staff member.

I had another crew tape ammonia inhalants to my brake pedal then color the tape black one day. Was not a happy camper when I hit the breaks coming off the freeway emergent. I have no idea where they even got them from, we don't use them.
 
Watched an ER Dr. twist a male pt.'s nipple. She was unable to get a response from him using some of the other methods. When the Dr. twisted the nipple, pt. yelled out and started swearing at her.
 
"Doing lasting damage" is not an issue.

Some people don't do sternal rubs because it will garner no response from some people that can otherwise respond to other stimuli such as trap squeezes or eye flicking. I still do them, and do them often as my first physical stimuli.


Honestly, some people just don't do it right. You don't go all EMT-student on the patient and give them a massage, you pull an ER-doc and lay some weight in to it.
 
cruiseforever said:
Watched an ER Dr. twist a male pt.'s nipple. She was unable to get a response from him using some of the other methods. When the Dr. twisted the nipple, pt. yelled out and started swearing at her.
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Had a former partner that regularly used the nip twist, definitely more effective than the sternal rub.
 
Like someone else said, I do whatever is convenient at the time, which is usually a sternal rub. I had to laugh when an idiot partner I had tried a sternal rub on someone and then shook his hand and said ow that hurt. I told him well I guess we established you're responsive to pain anyway.
 
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