Sternal rub... who's doing it?

And with the nipple twist or the sternal rub, I'd be more than careful not to employ such pain response stimuli on females.
 
I have been lucky in that I have only had a hand full of fake unconscious patients. And I have decided that the next one I get gets an OPA attempt. (You know airway management). OK maybe not but boy will I be thinking about it.
 
FireWA1 said:
I have been lucky in that I have only had a hand full of fake unconscious patients. And I have decided that the next one I get gets an OPA attempt. (You know airway management). OK maybe not but boy will I be thinking about it.
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I have used the NPA. No sense in unnecessarily causing them to puke.
 
FireWA1 said:
I have been lucky in that I have only had a hand full of fake unconscious patients. And I have decided that the next one I get gets an OPA attempt. (You know airway management). OK maybe not but boy will I be thinking about it.
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Why would you want to do that?
 
Kidding. I do believe in do no harm, but I will admit I have thought about doing so. I'm not a big fan of walking up to a door hearing two people talking. Then when we are let in there is one conscious person and one obviously "unconscious." Why? Because the conscious person said the patient must go to Harborview (three hospitals away) only to get off our stretcher in the ambulance bay and walk away yelling thanks for the ride.
 
FireWA1 said:
Kidding. I do believe in do no harm, but I will admit I have thought about doing so. I'm not a big fan of walking up to a door hearing two people talking. Then when we are let in there is one conscious person and one obviously "unconscious." Why? Because the conscious person said the patient must go to Harborview (three hospitals away) only to get off our stretcher in the ambulance bay and walk away yelling thanks for the ride.
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Meh. It's easier (and better) not to care too much. If someone wants to play games, just scoop, drop and cut your paper quickly.
 
I've found the supraorbital notch handy in some situations. I've never even heard of the hand drop test. Sounds kind of odd.
 
gnosis said:
I've never even heard of the hand drop test. Sounds kind of odd.
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It is odd. It is based on some odd reasoning that supposes that a fully alert frequent flyer who wishes to feign unresponsiveness - and who is presumably aware of the standard tests for such - will somehow not think to allow his hand to contact his face when it is dropped from a few inches above.....even after enduring other, much more painful stimuli.
 
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EMS did sternum rub on my 17yo daughter last night. Two sets, one from FD and one set from ambulance service. She had chest pain from it earlier but she's fine now. It was really the only thing she responded to.

We think she was having reaction to new medication, in case anyone was curious.
 
How often is everyone having someone who is truly faking it? While I agree it does happen with how often people are talking it almost seems commonplace. Maybe you should be believing these patients are unconscious instead of trying to prove they are "faking it." Its the same workup either way.
 
I used to encounter folks faking seizures with enough regularity that it came to a point that I'd always consider that it may be fake. Same with unconsciousness, I had enough either just not wanting to respond or just faking for one reason or another that it was something that I would consider.

I still do sternal rubs (but have begun squeezing the trapezius) and I do on occasion do the hand drop (though I make sure to avoid the nose in case they either know the trick OR if they're actually unconscious). I have seen and done a lot of sternal rubs and have yet to see anything that would persuade me from doing it again.

My practice in EMS was to treat them as legit even if they failed the hand drop and I couldn't get them to "wake up", which would mean I'd place a NPA, start an IV, check a blood sugar, and ride with them to the hospital. Usually the NPA would wake them up or they would turn their head back and forth to which I'd stop.

I do think it okay to consider malingering, etc., and employ some tests to check for it, but ALWAYS default to treating them as if they are legitimately unconscious even if you think for sure they are malingering.
 
medicsb said:
I do think it okay to consider malingering, etc., and employ some tests to check for it, but ALWAYS default to treating them as if they are legitimately unconscious even if you think for sure they are malingering.
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Completely agree. CYA all around.
 
I agree that in the field it may not make much of a difference if it is true/fake unresponsiveness (assuming normal blood sugar, etc), but once you bring the pt to the ER, it will help us determine what kind of work up to procede with. I'd rather not irradiate someone who is faking it, especially if they have had multiple CTs in the past. I wouldn't recommend using any of the above tests to see if someone is truly unresponsive or not, but if you are questioning if it is realy, then these tests can be helpful, although I would never encourage the nipple twist since there are so many other, but just as obnoxious stimuli you can use (in 24 years, I have never used it).
 
I like the hand drop test when I'm trying to work out if they're faking it. I can't imagine that they would hurt themselves if their hand hit their face, just not enough force there to break their nose unless you're flinging their hand down on them. Gotta be sure you do it right though, I've seen it happen where the angle of their arm will naturally allow their hand to move and miss them as it falls, so you gotta line it up right.

We get a fair number of HP (hispanic panic) calls here where a family member is feigning unconsciousness for whatever reason, so I get to practice this one quite a bit.

Another good pressure point is right behind the ear at the angle of their jaw.
 
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