The sternal rub is a medical technique used to assess a person’s level of consciousness, particularly when they are unresponsive to verbal or gentle tactile stimuli. It serves as a method to determine if an individual can react to a painful stimulus. The goal is to elicit a response from an unresponsive individual, providing insight into their neurological status.
Understanding the Sternal Rub
Performing a sternal rub involves applying firm, circular pressure to the sternum, or breastbone, using the knuckles of a closed fist. The knuckles of the second and third fingers are used to rub vigorously up and down or in a grinding motion along the center of the sternum. This action creates a deliberate, painful stimulus. The physiological principle is that a conscious individual’s body will naturally react to such discomfort, which can range from verbal outcries or grimacing to attempting to push the stimulus away.
When and Why It Is Used
The sternal rub is employed in emergency medical assessments, especially when a person is found unresponsive or exhibits an altered mental status. It helps medical professionals determine the depth of unconsciousness or the presence of a pain response. This technique is integrated into neurological assessments such as the Glasgow Coma Scale (GCS), which evaluates a patient’s motor response to pain. For instance, it can be used to assess patients after a fall, in cases of suspected overdose, or when there is unexplained unresponsiveness.
Different responses to a sternal rub indicate varying levels of neurological function. A fully conscious person will react immediately, trying to move away or verbalizing discomfort. A delayed or weak response, such as groaning or slight movement, might suggest a disoriented state or stupor. Conversely, a complete lack of response could indicate a deeper level of unconsciousness, such as a comatose state. This information helps guide initial treatment decisions and provides a rapid assessment of the patient’s condition.
Important Considerations and Precautions
A sternal rub carries potential risks, including skin bruising, abrasions, or bone fractures, especially if excessive force is applied or in individuals with fragile bones like those with osteoporosis. This technique should be performed by trained medical professionals, such as paramedics, nurses, or doctors, who possess the knowledge to apply it correctly and interpret the results within the broader clinical context.
A sternal rub is an assessment technique, not a diagnostic tool. Ethical considerations suggest using the least noxious stimulus necessary to elicit a response. Alternative painful stimuli include the trapezius squeeze, which involves pinching the muscle between the neck and shoulder, or supraorbital pressure, applied to the bony ridge above the eye. These alternatives may be preferred if the sternum has existing injuries or a less invasive option is more appropriate.