What is a Sternum Rub?
A sternum rub is a physical maneuver used to assess a person’s level of consciousness. It involves applying firm, vigorous pressure to the sternum, or breastbone, using the knuckles of a closed fist. This technique aims to create a painful sensation, provoking a response from individuals unresponsive to verbal commands or gentler stimuli.
Why Medical Professionals Perform It
Medical professionals employ the sternum rub as a noxious stimulus to gauge a patient’s neurological responsiveness. This technique is commonly used in emergency situations to quickly determine if an unresponsive patient has any level of brain function. Observing reactions like grimacing, moving, or attempting to remove the stimulus provides insight into the patient’s neurological status. It serves as a diagnostic tool, helping assess the severity of a patient’s condition, sometimes as part of a broader neurological assessment like the Glasgow Coma Scale.
Potential for Harm
While intended for assessment, a sternum rub carries the potential for physical and psychological harm. Forceful rubbing can lead to bruising, skin abrasions, and localized skin damage. Individuals with fragile bones, such as those with osteoporosis, or pediatric patients face an increased risk of fracturing ribs or the sternum. Pre-existing conditions like chest trauma, recent sternal surgery, or compromised skin integrity also increase susceptibility to injury.
Beyond physical injury, there is a risk of psychological distress or trauma, particularly if the patient is conscious but unable to respond or recall the event later. Applying a painful stimulus without clear justification or in a non-emergency context can be distressing. Additionally, misinterpreting a lack of response could delay appropriate care, as some patients may require a longer duration of stimulus to react.
Ethical Considerations in Practice
The use of a sternum rub involves ethical considerations, especially the principle of “do no harm.” Medical professionals are responsible for minimizing patient discomfort and potential injury. Therefore, a sternum rub should only be employed when clinically indicated and after less invasive assessment methods have proven ineffective.
Proper training is essential for medical personnel to ensure the technique is performed with appropriate force and duration, avoiding excessive pressure. Individual patient factors, such as age, bone fragility, or existing injuries, must also be considered, as they might contraindicate its use. Careful application ensures the assessment provides useful information without causing undue harm or distress.
Alternative Assessment Methods
Medical professionals use several alternative methods to assess a patient’s consciousness and responsiveness, generally before resorting to a sternum rub. The least invasive methods involve verbal stimuli, such as speaking loudly and clearly or giving simple commands like “Open your eyes!” If verbal cues are unsuccessful, gentle physical stimuli, like a light shake of the shoulder, may be attempted.
Other painful stimuli considered less invasive than a sternum rub include the trapezius squeeze, which involves pinching the trapezius muscle between the neck and shoulder. Supraorbital pressure, applying firm pressure to the bony ridge above the eye, is another option. Nail bed pressure, involving firm pressure on the nail bed, can also elicit a response. These alternatives are preferred due to their reduced risk of physical harm compared to a sternum rub.