The sternal rub is a medical technique used to assess a patient’s level of consciousness, particularly when they are unresponsive to verbal cues or gentle touch. It involves applying a painful stimulus to the sternum, or breastbone, to provoke a reaction. This method determines if a patient has any neurological response to pain, providing insight into brain function in emergency medical situations. It is a quick, non-invasive way for medical professionals to gain information about a patient’s state when time is critical.
Understanding the Sternal Rub
The sternal rub elicits a response from an unconscious or unresponsive patient by delivering a noxious stimulus. This action assesses a patient’s responsiveness in urgent medical scenarios. By observing a patient’s reaction, or lack thereof, medical personnel can gauge if there is any neurological processing of pain signals. This assessment helps in understanding the severity of a patient’s condition and guiding immediate treatment decisions.
The technique relies on the principle that even deeply unconscious individuals may exhibit some form of reflexive or purposeful movement in response to significant pain. It is one of several methods used to check for pain response and evaluate neurological function. The sternal rub is employed when less invasive stimuli, such as calling the patient’s name or gently shaking them, have failed to produce a response.
Step-by-Step Guide to Performing
To perform a sternal rub, first ensure the patient’s sternum is accessible and free from any recent injuries or surgical sites. Make a firm fist with one hand, positioning the knuckles of your index and middle fingers directly onto the center of the patient’s sternum.
Once positioned, apply firm, controlled pressure and rub your knuckles vigorously up and down or in a circular motion along the sternum. The motion should be robust enough to create discomfort and elicit a response, but not so forceful as to cause injury. Continue the rub for a few seconds, typically between 5 to 10 seconds, while closely observing the patient for any reaction.
The aim is to apply consistent pressure to provoke a neurological response, indicating the brain’s ability to receive and interpret the painful stimulus. If the patient does not respond within a reasonable timeframe, it may indicate a severe alteration in their neurological status.
Important Safety Considerations
While the sternal rub is a useful assessment tool, it carries potential risks and is not appropriate in all situations. It should not be performed if there is suspected chest trauma, such as rib fractures or sternal injury, as this could worsen the patient’s condition. Recent sternal surgery or skin integrity issues like burns or open wounds in the chest area are also contraindications, as the rub could cause further damage or infection.
Patients with fragile bones, such as those with severe osteoporosis, are at an increased risk of fractures from the pressure applied during a sternal rub. Consider the patient’s overall medical history and physical condition, as excessive force or prolonged application can lead to bruising, skin abrasions, or discomfort. The sternal rub is a stimulus of last resort when other less invasive methods of assessing consciousness have failed.
Interpreting the Patient’s Response
The patient’s reaction, or lack thereof, to a sternal rub provides valuable information about their neurological status. A positive response can manifest in various ways, such as grimacing, moaning, opening their eyes, or attempting to withdraw from the painful stimulus. They might also try to push away the hand applying the pressure, which indicates a higher level of brain function. These reactions suggest that the brain is receiving and processing the painful input, even if the patient is not fully conscious.
Conversely, a complete lack of response to a sternal rub signifies a deeper level of unconsciousness or a significantly altered neurological state. This unresponsiveness suggests that the brain may not be effectively interpreting the stimulus or sending out an appropriate motor response. The information gathered from a sternal rub, along with other observations, contributes to a broader assessment of consciousness, helping medical professionals understand the extent of neurological impairment.