A sternal rub involves applying firm pressure with knuckles to the sternum, the flat bone in the middle of the chest. This technique has historically served as a method for assessing responsiveness in individuals who are unconscious or unresponsive to verbal cues. Despite its past prevalence in medical settings, healthcare professionals now largely do not recommend its use.
Traditional Use of the Sternal Rub
Historically, medical personnel used the sternal rub to quickly gauge a patient’s level of consciousness. The technique involves vigorously rubbing knuckles across the sternum to create a painful sensation, prompting a response if the patient has some awareness.
The rationale was that eliciting a pain response indicated if a patient’s brain was receiving and interpreting stimuli. It was a rapid way to determine if a patient could react to a noxious stimulus, especially when gentler attempts, such as talking or light touch, failed to provoke a reaction.
Why the Sternal Rub is Problematic
The sternal rub presents several issues leading to its disrecommendation. One concern is its unreliability in assessing neurological conditions. It may not consistently elicit an accurate response, leading to misinterpretations of a patient’s true state of consciousness. Patients under sedatives or alcohol might not respond reliably. Anecdotal reports suggest some patients require a continuous rub for up to 30 seconds, making brief applications misleading.
Another problem is the risk of physical harm. Applying vigorous pressure can result in bruising, skin abrasions, and soft tissue damage. In vulnerable individuals, such as the elderly or those with osteoporosis, it risks fractures to the sternum or ribs. If a patient has pre-existing conditions like chest trauma or recent sternal surgery, this technique could exacerbate their injuries.
Ethical considerations also weigh against the sternal rub. Intentionally inflicting pain on an unconscious patient is undignified and goes against the “do no harm” principle. When safer alternatives are available, causing unnecessary discomfort raises ethical questions about patient care. The jarring nature can be distressing for patients if they regain consciousness or for family members witnessing the assessment.
The sternal rub also lacks specificity in providing detailed diagnostic information. It primarily indicates whether a patient reacts to pain, but offers limited insight into the precise level of unresponsiveness or the nature of their neurological impairment. This method does not effectively distinguish between different types of pain responses, which are important for a comprehensive neurological assessment like the Glasgow Coma Scale. The absence of standardized guidelines for its application further contributes to inconsistent and inaccurate assessments.
Recommended Alternatives for Pain Stimuli
Modern medical practice favors alternative methods for assessing pain response that are safer and more precise. These techniques elicit a response with reduced risk of injury or discomfort.
- Trapezius squeeze: Grasp and twist one to two inches of the trapezius muscle, located between the neck and shoulder. This sensitive area provokes a response without significant tissue damage.
- Supraorbital pressure: Apply upward pressure with a thumb to the bony ridge above the eye socket, near the nose. This targets a sensitive nerve area, effectively stimulating pain while minimizing injury.
- Nail bed pressure: Apply firm pressure to the patient’s nail bed, often with a knuckle or a pen.
These alternatives are preferred because they are less likely to cause bruising or abrasions and provide a more localized and reliable pain stimulus. They allow healthcare professionals to assess a patient’s response to pain effectively and safely, aligning with current patient care standards.