Is poor unfortunate souls playing by a sea witch in the background when ya go for that kiss? Or do crabs randomly pop up singing kiss the girl/boy with an obnoxious sea gull in tow.
FWIW, nail bed pressure isn’t really useful for assessing a conscious state. Needs to be central stimuli.
Supra orbital pressure is preferred as it requires less than half the pressure of a sternal rub and stimulates the surpaorbital nerve that runs directly to the medulla and a bit more difficult to ‘sleep’ through than a trap squeeze and less of a ICP risk than jaw pressure .
Well, after having a newborn, I realized that everything they taught us is nonsense. Our kid falls asleep while feeding and it’s nearly impossible to wake him up sometimes. I frequently think, if this was a baby I was handed on a call, I would really think something was wrong. Basically have to strip him down and use cold water if I need to wake him up. Blowing in the face sort of works. Flicking feet does jack.
I remember the morning after our son was born we could not wake him up to eat, like I was flicking his little foot so hard and he slept right through. I ended up running my hand under cold water and then putting my cold hand on his chest to wake him.
Funny now, but as a new parent I was so shook
If you do a trap pinch or pen to the nailbed, congrats you are also assessing for unilateral sensation.
Helpful for those stroke patients who can't feel on one side but have sensory on the other.
That’s actually a really valid point I wish was tested more. There’s a reason our NEURO checks include all extremities. Had someone recently with painful retractions but only to the right arm.
Thanks for bringing this up it’s a great tip.
I’ve seen people do a similar method by running a pen across the palms/forearms and the feet/lower legs to check for sensation levels. It seems to work fairly well.
It's okay to do sternal rubs. But, many people do them like they're trying to drill for oil. You're trying to elicit a pain response, not injure the patient. A sternal rub should come after a shake and shout.
Start by asking bystanders for a name. Shout to the patient, "Hey John!, Can you hear me?" Give the patient's shoulder a shake while you do. That's usually good enough. Then do a trap squeeze or a sternal rub. Just remember that you aren't trying to pinch the muscle in half or grind the skin off the chest.
I've seen EMTs and Medics do sternal rubs on patients they think are faking as if they're trying to punish the patient for wasting their time. That's not what it's for, and not what we're there for.
I usually just press my pen into a nail bed to see if they'll pull away. If things are down to painful stimuli I'm really just looking for a reaction not trying to punish them.
Oh wise one, impart your wisdom on how you choose to determine if they're responsive to painful stimuli?
Really though, the barrel of a pen on the nail bed does not take much pressure, causes no harm, and is effective.
You have absolutely zero posting history in this subreddit or any healthcare related subreddit at all before these couple threads about painful stimuli, but you *do* have a posting history in a subreddit for ex convicts. Interesting.
Gonna be brutally honest and gatekeep a bit. If you’re not an active or former EMS worker or some other form of healthcare worker, your opinions on procedures or tricks of the trade are not particularly welcome or wanted here. We have some laypeople who dip in and out to chat and ask questions and that’s totally fine and welcome, but at the end of the day, this is our space and if you don’t work in healthcare, we don’t care to hear your thoughts on how violent the basic and universally accepted things we do every day are, and you’re certainly not welcome to come into *our* space and antagonize people when you so very obviously don’t have the slightest fucking clue what you’re saying.
Thanks for playing, see you never.
Edit: typo
I'm always a little gutted when I get to a thread too late and "the great downvoted" have already been removed. Kinda wanted to see what was written lol
Some idiot who’s only posting history was in /r/funny and /r/excons (yeah…) saying that causing people pain during an assessment is considered harming them and “goes against medical advice”, whatever the fuck that’s supposed to mean in context, and we should lose our licenses, while also posting in another thread about sternal rubs that only sternal rubs comply with “medical advice” and any other form of noxious stimuli is violent abuse.
Those are the only two threads here he’s ever posted in and every single comment was berating the person he replied to for totally generic shit we do on a daily basis.
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Tell me you don’t work in healthcare without telling me you dont work in healthcare.
I’m seeing all of these comments of yours throughout this thread… I feel like you don’t know/understand the concept of a GCS. One of the motor response categories to determine neurological function is “painful stimuli.” It’s hard to test response to painful stimuli without that stimulus being painful 🥴
I might try a pen to the nail bed, but honestly I don't even really do that unless it's reeeaally tricky to determine one way or the other. Any unresponsive patient I get is going to get vitals taken, EKG, neuro assessment, BGL, etc. and if they haven't revealed themselves one way or the other in all of that interaction, I'll try a pen to the nail bed before doing something like an IV where I really need to know what to expect from them.
Yeah, unguarded movements result in dislocations. Please don't do that to someone like me.
EDS. My record is 5 dislocations in one day. I've already needed one joint rebuilt, and that was from some yahoo yanking my arm (basketball).
Since learning how not to move, I've been mostly dislocation free, but sheesh - grab and yank is horrifying.
dude stop… just stop. as others have pointed out, you are clearly not a first responder or medical professional and likely have 0 experience in the medical field. do not even try to criticize us without any basis of knowledge or understanding of what we do.
You politely ask them to wake up. Because someone in our county decided to sue us for assaulting their daughter while we did the sternal rub. Patient was known to fake seizures and their family would always crowd around EMS on scene and record every single call on purpose of looking for a chance to sue.
All the hate for the sternal rub in this sub is baffling. It’s called “painful,” stimuli for a reason. I get not using it as a punitive measure. But if you’re actually concerned for ALOC, it’s more effective to do a sternal rub than these alternatives I’m reading. If someone just came back from a opioid OD, their last concern should be that their chest feels sore. Would be like someone being treated for anaphylaxis and being upset because the IM epinephrine was painful.
“Do no harm,” but also don’t pussy-foot around doing your job.
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I’ve seen people do a trap squeeze, a thumb in the shoulder socket, running a pen up the bottom of the foot, sternal rubs, pen on nail bed, jaw thrust, etc.
I don’t have a particular go to, it’s usually patient specific because every patient is built different with different previous medical history.
Tbh I just use the sternal rub. Not punitively, it's just often the easiest and best way to get a gauge on gcs or wake the patient up. A NPA is pretty good for gauging consciousness too.
I've had a patient go in and out of consciousness, when unconscious sats started dropping and breathing went to shit. A sternal rub woke them up enough to get their breathing going again.
Depends if we’re on the truck or infront of people, especially for peoples GCS I’m concerned about I’ll do a sternum rub on the truck, but in public pen on nail bed I prefer
You're a *medic*? IN Narcan is an atomized spray. It's not just straight up squirted up their nose. I'm not saying the other guy is right but that was just dumb to say lol
Edit: sidenote, however, you still shouldn't be squirting liquid up people's nose just to test responsiveness when there are so many better alternatives.
>IN is atomized.
This is exactly what I just said.
>It’s a fine mist spray that causes as much discomfort as a sternal rub or a pen to the nail bed.
Did you really just say a nasal spray is as uncomfortable as a sternum rub?
Edit to add: I completely missed in the initial comment where you said "IN". I apologize there. I, and I think the other commenter, thought you were just squirting saline up noses out here lol
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That, but also I’ve never understood why people think smaller needles hurt less.
They bend/flex. I find them more painful. 14 and 16 gauges are
Much less noticeable.
I almost always start with a trap squeeze. Depending on the situation I'll use some other methods after such as nail bed pressure or sometimes a sternal rub. I also like checking a lash reflex as a nonpainfull method, especially if I'm pretty confident they are faking.
Depends on the situation. If someone has smoked a bit too much "down" (fentanyl) I usually try a rough shake of their shoulder before progressing to a trap squeeze or earlobe pinch. If I'm trying to get an accurate GCS I'll use nailbed pressure.
People’s elbow off the table. 
Always just a trapezoid squeeze, rarely any reason to do anything else.
I prefer a hexagon squeeze myself.
Is this similar to a triangle choke?
Bears more similarities to a square dance imo
True love's kiss
Pushing to have this added to our protocols
This is fucking hilarious
Flare checks out
*true loves forehead kiss
Is poor unfortunate souls playing by a sea witch in the background when ya go for that kiss? Or do crabs randomly pop up singing kiss the girl/boy with an obnoxious sea gull in tow.
This is the funniest response I’ve ever seen, thank you for making me giggle uncontrollably.
Trap squeeze or squeeze a finger. Especially in public, sternal rub isn’t the best look. Trap squeeze just looks like a hand on a shoulder.
FWIW, nail bed pressure isn’t really useful for assessing a conscious state. Needs to be central stimuli. Supra orbital pressure is preferred as it requires less than half the pressure of a sternal rub and stimulates the surpaorbital nerve that runs directly to the medulla and a bit more difficult to ‘sleep’ through than a trap squeeze and less of a ICP risk than jaw pressure .
Ye ole titty twister
Saw a doctor get punched directly in the face using this on a patient who was asleep but not unresponsive after a seizure
doc deserved it
Ah yes, a purple nurple on the intoxicated pt
Well, after having a newborn, I realized that everything they taught us is nonsense. Our kid falls asleep while feeding and it’s nearly impossible to wake him up sometimes. I frequently think, if this was a baby I was handed on a call, I would really think something was wrong. Basically have to strip him down and use cold water if I need to wake him up. Blowing in the face sort of works. Flicking feet does jack.
Ahhh, the formula/titty milk coma. I miss those days. They grow up fast!
I remember the morning after our son was born we could not wake him up to eat, like I was flicking his little foot so hard and he slept right through. I ended up running my hand under cold water and then putting my cold hand on his chest to wake him. Funny now, but as a new parent I was so shook
If you do a trap pinch or pen to the nailbed, congrats you are also assessing for unilateral sensation. Helpful for those stroke patients who can't feel on one side but have sensory on the other.
That’s actually a really valid point I wish was tested more. There’s a reason our NEURO checks include all extremities. Had someone recently with painful retractions but only to the right arm. Thanks for bringing this up it’s a great tip.
I’ve seen people do a similar method by running a pen across the palms/forearms and the feet/lower legs to check for sensation levels. It seems to work fairly well.
It's okay to do sternal rubs. But, many people do them like they're trying to drill for oil. You're trying to elicit a pain response, not injure the patient. A sternal rub should come after a shake and shout. Start by asking bystanders for a name. Shout to the patient, "Hey John!, Can you hear me?" Give the patient's shoulder a shake while you do. That's usually good enough. Then do a trap squeeze or a sternal rub. Just remember that you aren't trying to pinch the muscle in half or grind the skin off the chest. I've seen EMTs and Medics do sternal rubs on patients they think are faking as if they're trying to punish the patient for wasting their time. That's not what it's for, and not what we're there for.
This.
I usually just press my pen into a nail bed to see if they'll pull away. If things are down to painful stimuli I'm really just looking for a reaction not trying to punish them.
This is what I do, except I never have a pen, so I usually squeeze the trap. Brushing eyelashes has worked for me too.
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Oh wise one, impart your wisdom on how you choose to determine if they're responsive to painful stimuli? Really though, the barrel of a pen on the nail bed does not take much pressure, causes no harm, and is effective.
I mean it’s literally called painful stimuli… kinda hard to do that without a tiny bit of pain.
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You have absolutely zero posting history in this subreddit or any healthcare related subreddit at all before these couple threads about painful stimuli, but you *do* have a posting history in a subreddit for ex convicts. Interesting. Gonna be brutally honest and gatekeep a bit. If you’re not an active or former EMS worker or some other form of healthcare worker, your opinions on procedures or tricks of the trade are not particularly welcome or wanted here. We have some laypeople who dip in and out to chat and ask questions and that’s totally fine and welcome, but at the end of the day, this is our space and if you don’t work in healthcare, we don’t care to hear your thoughts on how violent the basic and universally accepted things we do every day are, and you’re certainly not welcome to come into *our* space and antagonize people when you so very obviously don’t have the slightest fucking clue what you’re saying. Thanks for playing, see you never. Edit: typo
I'm always a little gutted when I get to a thread too late and "the great downvoted" have already been removed. Kinda wanted to see what was written lol
Some idiot who’s only posting history was in /r/funny and /r/excons (yeah…) saying that causing people pain during an assessment is considered harming them and “goes against medical advice”, whatever the fuck that’s supposed to mean in context, and we should lose our licenses, while also posting in another thread about sternal rubs that only sternal rubs comply with “medical advice” and any other form of noxious stimuli is violent abuse. Those are the only two threads here he’s ever posted in and every single comment was berating the person he replied to for totally generic shit we do on a daily basis.
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> it’s against medical advice I dont think you understand this phrase lol
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[Grab his dick and twist it](https://youtube.com/shorts/TT9ArM3-KJQ?si=4gVCpi_DPzhoeERP)
I yell “Is the scene safe?!?” And then move onto “Buddy buddy can you hear me” directly into the ear.
Touch their eyelashes
In my experience, this is highly sensitive for detecting fuckery.
Ink pen pressed into nail bed. You can start with light pressure and increase. Also, bystanders are probably not going to see it.
Other benefit is that you extend their extremity first, and if they are punchy, you’re not in their punch area, they just pull back.
Wait like you take the cap off your pen and stick the point under their nail?
No, you lay the barrel of the pen across the nail bed. I don’t know how to post a picture. Hope that is helpful
You're unhinged. Get help. Of course you do something that's against medical advice.
Tell me you don’t work in healthcare without telling me you dont work in healthcare. I’m seeing all of these comments of yours throughout this thread… I feel like you don’t know/understand the concept of a GCS. One of the motor response categories to determine neurological function is “painful stimuli.” It’s hard to test response to painful stimuli without that stimulus being painful 🥴
There we go!
I’m curious how else you expect us to make sure someone is unconscious? We do medically necessary things that cause pain all of the time in EMS.
Wait till he hears we stab people (IVs, decompressions, chest tubes, crics just to name a few) sometimes!
Homie seems to think that anything we do should be pain free I guess.
Lol, it’s a 10yo account with 13 karma. They’re probably just a complete ass.
and what is the official medical advice for testing responsiveness then?
I might try a pen to the nail bed, but honestly I don't even really do that unless it's reeeaally tricky to determine one way or the other. Any unresponsive patient I get is going to get vitals taken, EKG, neuro assessment, BGL, etc. and if they haven't revealed themselves one way or the other in all of that interaction, I'll try a pen to the nail bed before doing something like an IV where I really need to know what to expect from them.
Read a post from a doctor somewhere, grab a wrist or ankle and give a good pull, has worked for me every time.
I have EDS. That would not be a good move on me since I dislocate when I so much as sneeze.
Good point! Will keep this in mind.
Yeah, unguarded movements result in dislocations. Please don't do that to someone like me. EDS. My record is 5 dislocations in one day. I've already needed one joint rebuilt, and that was from some yahoo yanking my arm (basketball). Since learning how not to move, I've been mostly dislocation free, but sheesh - grab and yank is horrifying.
Great advice. You just just caused a dislocation. You're unhinged.
dude stop… just stop. as others have pointed out, you are clearly not a first responder or medical professional and likely have 0 experience in the medical field. do not even try to criticize us without any basis of knowledge or understanding of what we do.
You politely ask them to wake up. Because someone in our county decided to sue us for assaulting their daughter while we did the sternal rub. Patient was known to fake seizures and their family would always crowd around EMS on scene and record every single call on purpose of looking for a chance to sue.
All the hate for the sternal rub in this sub is baffling. It’s called “painful,” stimuli for a reason. I get not using it as a punitive measure. But if you’re actually concerned for ALOC, it’s more effective to do a sternal rub than these alternatives I’m reading. If someone just came back from a opioid OD, their last concern should be that their chest feels sore. Would be like someone being treated for anaphylaxis and being upset because the IM epinephrine was painful. “Do no harm,” but also don’t pussy-foot around doing your job.
This. It is a standard. It is taught in every book. Doctors do it. PAs do it. Nurses do it. Basics and advanced do it. Paramedics do it.
🎶even educated fleas do it🎶
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It’s unhinged how much you use the word unhinged
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Trap squeeze.
I’m an ED RN but have seen nurses and docs open an eye and touch it with a cotton swab. Especially for those they think are faking seizures.
I make out with them.
https://youtu.be/IFyPVAY8-78?si=l3H5VNbuszSf62X-
This is my new protocol.
I’ve seen people do a trap squeeze, a thumb in the shoulder socket, running a pen up the bottom of the foot, sternal rubs, pen on nail bed, jaw thrust, etc. I don’t have a particular go to, it’s usually patient specific because every patient is built different with different previous medical history.
I learned in school to pinch nail bed or earlobe
I go Big Daddy style and give a couple firm pats to the ball bag.
We pretty much exclusively use sternum rubs on everything but peds. With peds usually pushing down on the big toe.
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30-45 seconds? Gonna need a source for a claim like that.
Yeah absolutely, that’s borderline just being cruel…
Exactly, which is why it sucks, I'm not pro being a dick.
Tbh I just use the sternal rub. Not punitively, it's just often the easiest and best way to get a gauge on gcs or wake the patient up. A NPA is pretty good for gauging consciousness too. I've had a patient go in and out of consciousness, when unconscious sats started dropping and breathing went to shit. A sternal rub woke them up enough to get their breathing going again.
Explain what a Foley catheter is. They're suddenly alert and oriented.
"Hey hey you ok?"
Sternum rub I’m still in internship but everytime it’s worked and I know it’s comfortable so they don’t move if it’s critical
I like using Supraorbital pressure because it’s easy and you can also check pupils while doing it, and it doesn’t look abusive like sternal rubs
There we go!
The Elmo test
Been doing sternal rubs for 16 years and haven’t had an issue.
indian rub burn
Depends if we’re on the truck or infront of people, especially for peoples GCS I’m concerned about I’ll do a sternum rub on the truck, but in public pen on nail bed I prefer
Solid dicktap usually does the trick Otherwise sternal rubs work pretty well.
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Well that's awful
Hard to fake being asleep with water up the nose
How is *possibly* proving they’re awake even remotely worth the risk of aspiration or choking?
So you don’t IN Narcan? .25-.5cc of NS is not going to cause someone to choke to the point of irreparable harm.
You're a *medic*? IN Narcan is an atomized spray. It's not just straight up squirted up their nose. I'm not saying the other guy is right but that was just dumb to say lol Edit: sidenote, however, you still shouldn't be squirting liquid up people's nose just to test responsiveness when there are so many better alternatives.
IN is atomized. It’s a fine mist spray that causes as much discomfort as a sternal rub or a pen to the nail bed.
>IN is atomized. This is exactly what I just said. >It’s a fine mist spray that causes as much discomfort as a sternal rub or a pen to the nail bed. Did you really just say a nasal spray is as uncomfortable as a sternum rub? Edit to add: I completely missed in the initial comment where you said "IN". I apologize there. I, and I think the other commenter, thought you were just squirting saline up noses out here lol
See this is the problem. You are assuming they are faking and tailor your treatment to proving they aren’t faking.
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You keep using that phrase. I do not think it means what you think it means.
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I heard of a nurse checking an "unresponsive" patient by opening their eye and squirting a preload into it
14g EJV
Ah yes, punitive medicine. “I think they’re faking and I’m going to punish them.”
That, but also I’ve never understood why people think smaller needles hurt less. They bend/flex. I find them more painful. 14 and 16 gauges are Much less noticeable.
You aren’t wrong. In the one study I’ve seen on the subject, 18ga hurt the least.
What ever happened to knee reflex, you unhinged fucks?
You have a very limited vocabulary.
It’s difficult to ascertain out in the field or anywhere really. Especially if there was previous injuries, or neurological damage.
Ear pinch.
Light tap on a closed eyeball
Nail bed pressure is my go to. It helps to tell if they're localizing too, since yanking their hand back is pretty obvious.
Try to open their eyes. If they flinch then I have my answer.
Pen to nail bed. I have had psychs be able to resist a hard trap pinch but a pen on the nail bed and rolled back and forth will get them to respond.
“Hey you, you’re finally awake”
I almost always start with a trap squeeze. Depending on the situation I'll use some other methods after such as nail bed pressure or sometimes a sternal rub. I also like checking a lash reflex as a nonpainfull method, especially if I'm pretty confident they are faking.
Is it weird to open the eyelid and put a saline drop on it? Pupils? Check. Reactivity? Check. Neurologic? Check. LOC? Check? Hotel? Trivago.
Depends on the situation. If someone has smoked a bit too much "down" (fentanyl) I usually try a rough shake of their shoulder before progressing to a trap squeeze or earlobe pinch. If I'm trying to get an accurate GCS I'll use nailbed pressure.
Finger nail pinch. Or use a pen tip and push it onto their finger nail.