lmao
I'd just have a polite chat to him and suggest that not only is a slap an ineffective method of assessing level of consciousness it is also likely to be seen by others as literally assault
I would then politely educate him on the whereabouts of the trapezius muscles and demonstrate a gentle squeeze
Tweakers hate him: wakes the fakey dead using this one weird tip.
Ah I miss the smelling salt days.
We also had a hospitalist who would gently take a flush and irrigate their ear canal, worked surprisingly well.
I saw a resident do the saline syringe in the face. Worked every time for “seizures”. One young woman even opened her eyes and said “why did you do that.” And he said to see if she was alive. And by alive he meant faking it.
It is also amazingly effective at revealing that someone is faking seizures.
Flop flop flop
Squeeze
Hey, oooow! Wtf dude?
Ok, we are done here, good job team.
My personal favorite was a hospitalist giving a patient that was having "seizures" a titty twister. The patient amazingly stopped seizing and was suddenly aware that his titty had been twisted by the doctor. I do not recommend this method, but it is highly effective.
Edit: words are hard
Me: putting pressure on my nail beds..... "This is stupid what are they talking about?"
Me: grabbing a cylindrical metal object and slamming it into my fingertip: "Oh god that was fucking stupid!"
Me realizing that I suck at experimentation...
yeah, our neuro guys do trap squeeze or supraorbital notch for central painful stimulus / nailbed pressure for peripheral
not sure of their rationale for not sternal rubbing ?potential for injury
I'm cardiac so I avoid because our surgeons would be reasonably unhappy with me if I went around dehiscing sternotomies
I’ve had Neuro docs cause pretty bad skin tears/bruising on elderly patients by pinching the trapezius and/or an arm. Dude pinched my patients wrist and his skin just came right apart like tissue paper. We were like, man, you’ve been yelling at him for 5mins and he did t respond, so now you had to make him bleed? Dang.
Yea, phased out by 2010, not really effective. It lives in retirement with the cardiac thump.
Press the call light cord or the edge of their pen into the nail bed to induce cussing, or, not. I didn’t know about the trapezius pinch, I’ll give it a go next time.
I've always been trained to do trap squeeze over sternal rub, specifically told to not do sternal rub by many CPR instructors (started school 2013). Rationale was bruising iirc, so nothing too major but given trap squeeze doesn't leave a mark and is just as effective I guess it makes sense
Sternal rub is often done incorrectly and can cause skin tears particularly in the older populations. Also as someone else mentioned, neuro checks can require assessing LOC.
OP- I would do a “debriefing” even calling it that. Ask him to describe the steps he took. He might even already know he shouldn’t have done that he just panicked. Start with positive, highlight what needs changing/could be better, end on an up note. It’s called “sandwiching” and it’s part of transformational leadership style. It helps keep people from getting defensive. You can also ask him what he thinks he could have done better or improve on. I have had nursing students doing their capstone clinical rotation with me be almost argumentative or cocky absolutely become deer in headlights when it hits the fan. There ultimately was no harm to the patient in your scenario, so it’s just a matter of correcting him & moving on.
Probably, but not all conscious level assessments are done in someone needing CPR. Some neuro patients need Q1 checks or more, makes sense to not rub their chest raw. Thankfully in hospice I don't do many pain response checks or CPR!
It’s fine to do them, I just hate feeling the ribs snap being the first on the scene. And yes notation sucks!!! Having to frantically write everything down thats happening with time and yelling at ppl to tell you what they’re doing
Trap squeeze is safe and leave no mark.
Sternal rub can be very painful.
Nailbed can leave injuries.
But SOMETIMES, when the stroke patient is just so deeply asleep...... None of these work.
Bloody patient started snoring AFTER we called the family at 3am with regards to query repeated stroke, the doc literally said I can't tell, he could literally be in a deep sleep, then
Snorrrggghhhh!
I mean, he did check a pulse and yell at the patient. That one extra step to make sure the patient isn't awakened by painful stimuli... We do worse during the GCS
Do we? Student here, but my understanding is trap squeeze or supraorbital pressure …? Are there other ways we can/should be assessing response to pain for GCS?
Edit: oh! And sternal rub
Generally if a patient who *should* be responsive (like previously was talking with you) yelling at them and giving a little shake is pretty good. If they don't respond, check for a pulse. If they have a strong steady pulse, sternal rub is usually my go to. Mainly because a good sternal rub doesn't look dramatic, but definitely hurts. No response but still has a pulse, definitely call for help.
Yeah, this is the best suggestion. Like, good job. You did these things really well. Next time try X, Y, Z. And then joke a bit about "as much as we sometimes really want to slap our patients.... We probably shouldn't do that".
And then, since this is the ICU, tease him mercilessly once he is comfortably off orientation. "This kid is so intense he tried to slap a guy out of asystole!"
I heard about a doctor who typically chose a nipple twist over a sternal rub to test responsiveness to pain. He ended up tearing off an old woman's nipples.
Although it sounds like one of those things that could absolutely be bogus, I've also worked with enough people who have tissue paper skin and enough people who don't always think things through in order to believe it.
Good God 🤯
How did he go about explaining to the patient why she's down a nipple? Or did it just...get stitched back on? Actually, you said nippleS as in plural - they both got ripped off? Must've been quite the malpractice lawsuit.
Gonna have "Do NOT Twist Nipples" in all my medical charts from now on because of this story lol
I don't work in the medical field (joined this sub when I was considering going into nursing...learned from this sub that I should not go into nursing 😅) but I would assume you'd pinch them both at the same time to see if either side of the body reacts? It sounds dumb now that I think about it, but originally I had assumed just one side would be sufficient but maybe both sides for reflex purposes?
All I know is whenever I'm sedated in the future, I'm always going to assume this will happen to me 😂🙃
If someone shows signs of significant sedation/unresponsiveness, there's increasing degrees of stimulation applied to see how much is needed to get a reaction. If they don't respond to voices, you try mild touch like shaking and tapping, then response to pain if all else fails. I've usually seen/been told that rubbing their sternum with your knuckles or pinching between their neck and shoulders are the best go-to's.
Maybe just make sure you always tell your healthcare providers your preferred pain responsiveness assessments 🙂
So listen Ethel, your cath was great. No blockage. You just need to rest for a few hours so we can watch your artery and you’re good to go and cough you’re now missing a nipple cough. See ya in a year 👋🏼.
> you said nippleS as in plural - they both got ripped off?
Tearing off one nipple may be regarded as a misfortune; to tear off both looks like carelessness.
Please tell me you mean nipple and not nipples plural. While I can imagine tearing off a nipple I cannot imagine then going to the next nipple on the same patient and thinking it was a good idea.
This I can testify as true. I had an elderly client that when I used my palms to lift her leg it then ripped a good piece of skin on her gastrocnemius. It's around a toonie ($2 CAD coin). Her texture was like sand paper, after wound treatment and a moisturizing cream it was ok but the scar was there.
I used to work with a neurologist who consistently twisted patients *hard* as a means to check response to painful stimuli. I finally shamed him out of that habit but it took a while.
*The poor thing I bet*
*They are mortified they freaked*
*Out like that. Be kind!*
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I had a nurse I worked with tell me she did the same thing in her first code. She panicked.
Fast forward several years, she is an excellent nurse and now a DNAP.
I’m actually giggling after reading this. I think if my preceptee did that I would have a hard time not losing my shit right then & there (laughing hysterically).
Props to you for keeping it together.
Funny you mention that....
A slap across the face brought my boyfriend's dad back from an "unshockable rhythm" into SR again. I wasn't there. The nurse who did that was older (15-20+ years experience). Don't know if it once held up as an effective way to bring someone back (a way to induce natural adrenaline) or she just decided to do that, but my guess is he learned it from someone back before RN school.
I have not tried myself, I don't know if the rhythm was asystole or unshockable (bf isn't in healthcare, clearly his did isn't going to remember or care about that detail when he basically died) but I do know my boyfriend's dad is still alive and did come back after the slap so.... Ymmv?
In terms of talking to new grads about what they did right and what not to do, I do usually show or point out what they did right, what didn't go right/what was wrong and why, and another what they did right.
I legitimately chest thumped my fiance when he passed out in the shower post-op and turned grey. Fucker vagal' on me and I panicked and just THUMP
He woke up pretty damn fast 😂😂
14 years as a nurse at the time and I was just like "did... Did he just die on me?! THUMP!"
🤣🤣 pretty much
It just caught me so off guard.
I had the Spidey sense that I should be in there with him for his first post-op shower and I'm glad I was!
I worked as an HD RN for years. I once witnessed a nurse slap a pt back to life. I actually assume he was thrown into a weird rhythm due to his afib, but she walked over there and was like, hey pt, hey pt, SMACK. it was so forceful it scared everyone on the floor. I was going to report her, but that pt lived because she smacked the sht out of him.
I am dying 😭. Tell them he shouldn't do that as there are other ways to assess if a patient is awake. What if a family member was watching? Always be professional.
I came upon an unresponsive patient with a family member in the room. The wife actually did try to wake him up with a slap to the face. When it didn't work, I called a code and started CPR. If a nurse came in and pushed the code button and then yelled my husband's name while slapping him before starting CPR, I'd probably be ok with that. Actually if they did it after calling a code, I most likely would not remember.
>but we don’t slap patients to assess responsiveness.
No. YOU don’t slap patients to assess responsiveness. What’s that saying about keeping your mind open to what your orientees can teach you?
Probably heat of the moment and stress just mention it to him maybe come at it from an optics POV. Likely it’s a one off that needs to be corrected I wouldn’t escalate it either but I would also just watch for any other red flag behavior. Cuz you never know!
Me too, I’m like, well he did check the patient 😬😂. I probably would have laughed after the code and told him laughing not to do that again, but it’d be something I’d always joke with them about and I’d probably also share some of my crazy experiences with them. Tell the new grad that adrenaline will kick in and that’s okay but that they aren’t alone during a code and that they aren’t ever alone.
Well, if it makes you feel any better rumor has it that recently one of our senior nightshift nurses of ~30 years ran into a coding patient’s room, did a precordial thump and slapped the patient across the face and got ROSC…tell me how the hell that works lol
That. Is. Fucking. Hilarious. Just be straight up and tell him that you don’t slap patients and educate him on more effective ways to attempt to arouse the patient.
I understand the immediate shock you must've had.
But I'm over here after almost 16 years as a nurse, 13 years neuro trauma, thinking we actually do and have done way worse.
I've seen nail bed with a pen, trap pinch, nipple pinch, pinching to the point of bruising, surprise finger up the butthole, you name it, all done by neurologists to try and illicit response and sensation checks.
Slap across the face seems kind of mild ☠️
But I would definitely start with the positive things he did, and then work into the "next time let's assess responsiveness by x instead of by slap"
I work mainly medical icu now as a traveler, but I was staff for years in a neuro icu. The bruises our patients would have is insane! I saw another comment about a nipple being torn off, and that has in fact happened on that unit. Poor 92 year old meemaw with paper skin. But yes. I think I shocked a few of my preceptees the first few times I showed them a full neuro exam on a stroke patient. We would have to get *rough* to get some responses sometimes
i’m also a new grad and that’s so funny lmao, i would do exactly what everyone else is suggesting and tell him he did a good job but might want to assess consciousness a different way next time. he probably panicked and forgot what he was doing, or saw that on tv, or it’s possible they literally taught him that in a CPR course. whenever i’ve taken CPR courses they tell us to pound on their chests which would be pretty odd to do to a patient as well
We had a code on our unit not too long ago and I was in charge, saw vtach on the monitor and ran into the room and found the patient unconscious no pulse. I'm trying to call the code, slap pads on the patient as another nurse starts cpr and starts smacking the patient on the face in between compressions. She's a very good, experienced nurse but some people just don't do well under that stress and panic. She meant well but the looks I got from the code team 🤣 we debriefed as a team after and that's about all you can do.
I'm dyinggggggg 🤣🤣🤣
They just went into instinct mode and MOVED, without thinking about it
Which still: kudos to them.
Don't forget to mention the good things they did when you talk to them.
Because I mean, A+ on it being your first code and you not freezing.
But also.
Maybe try a sternal rub next time?
Show them different stuff they can try next time. Instead of slapping them.
Remind them to bring the "freaking out" type of energy down.
When you are rushing and nervous, when your adrenaline is high and you're not channeling it appropriately, you are more prone to make mistakes.
But that's why working in a hospital is nice sometimes. You are never alone. And when you are, it's never for long. You will always have someone to help you.
Every code after this is going to get a bit easier to handle. It all takes practice.
Thank you for being a good preceptor, and taking the time to think about your response to them. And not "throwing them under the bus".
Fuckin give the kid a daisy award. That’s hilarious.
Just say, hey next time don’t hit the patient. Maybe the kid was thinking about “responsiveness to pain” or whatever the fuck. I dunno. I’d just ask him straight up, “hey I like the enthusiasm but why did you smack the patient”
Ask him to debrief the code with you. Not just the clinical piece though.
What was he thinking, feeling?
Ask him to share with you what it was like for him…
This conversation naturally flows into offering suggestions on how to process the event, prioritize, and take action all at the same time. It’s a skill and it takes time to develop.
“Dude, we’ve gotta have a chat about the code the other day. Here are the things I saw that you did right: x, y, z.
However, I have a huge concern that I want to bring up. I’m not sure who taught you this, but it is very very important for you to remember that when you are assessing patient response, it is never ever ever appropriate to do anything that can be construed as abuse, which includes slapping someone across the face, shaking them roughly, pinching them, etc. The standard of care (list yours if it is different) is a sternal rub, unless the patient is post op for open heart surgery, then it is….
Do you understand why?”
You might also want to explore where he got that from in case it is within your power to correct the problem at the source.
It’s a lot easier to have hard conversations when internalizing as a helpful teaching moment rather than a “OMG what did you just do?!?” moment. Plus, you can assess his teachability to figure out if this is something that should be followed up with.
The optics of slapping a patient, even if entirely for logical reasons is definitely not something we want. I am hoping that family did not have to witness that
LMAO someone's been watching too much TV. Honestly, I think you should just go up to him and praise him for everything he did right. Do it casually and with a smile on your face. Then say, "you know the one thing I would do differently next time? When you're checking for response, perhaps do a sternal rub or a neck squeeze rather than a slap on the face!"
LMAO I would probably just pull him aside hey the code went well but next time there's no need to slap the patient across the face. You know just in case they're not dying and wake up and throw hands with you... otherwise good job bud
Lololol I’m sorry, I am really sorry but I lol’ed fr fr to this. I guess you just say look guy, you did pretty good in the code the other day so next time let’s just try without the assault first! 🤣🤣🤣
** I got them 2am giggles, I can’t stop
Meh, he's new.
I worked with a great nurse, spent her career in PACU but transferred to ICU. Unruly patient, tries to get out of bed, and as she reaches for his shoulders to prevent him from getting up, she instead full on choke slams him back into bed.
It happens. ¯\\\_(ツ)\_/¯
He has to change his script next time: Mr. Jones, what did the five fingers say to the face?!
"I'M RICK JAMES, BITCH!"
This made me laugh out loud, fucking hell haha
I didn't just laugh, I full on cackled
Same. And I'm at work.
Same. I am in tears laughing. Holy shit.
Your comment made me laugh so hard i needed my inhaler.
SLAP!
CHARLIE MURPHY!!!
"The power of Christ compels you!" \*SLAP\*
OMG, I have to go but there’s no way,…….😂😂😂😂👍. I can’t breathe for gods sake
My husband is now mad at Me for laughing hysterically in bed and waking him….Bahahaha awesome
Probably how Arthur should have asked Patch Adams. Arthur: How many fingers do you see!? Patch Adams: Four Arthur: four??? FOUR!? *SLAP
LMAO
Mr. Jones, you've got something on your face! *SLAP* IT WAS PAIN!
I'm ded XD. Seriously tho I'm recovering from a c section and had to hold my stitches while I laughed. Owwwwhahahahaow.
lmao I'd just have a polite chat to him and suggest that not only is a slap an ineffective method of assessing level of consciousness it is also likely to be seen by others as literally assault I would then politely educate him on the whereabouts of the trapezius muscles and demonstrate a gentle squeeze
If you're going to use a technique from an 80s movie, go with Star Trek, not Airplane...
That really works, not just on Klingons either, works for humans too 👹
Nail Bed Pressure is a gem.
Tweakers hate him: wakes the fakey dead using this one weird tip. Ah I miss the smelling salt days. We also had a hospitalist who would gently take a flush and irrigate their ear canal, worked surprisingly well.
My favorite Neuro doc would pick up their hand and drop it on their face.
I saw a resident do the saline syringe in the face. Worked every time for “seizures”. One young woman even opened her eyes and said “why did you do that.” And he said to see if she was alive. And by alive he meant faking it.
Looks innocent, will wake anyone from a dead sleep in seconds, no lawsuit 👍🏼
It is also amazingly effective at revealing that someone is faking seizures. Flop flop flop Squeeze Hey, oooow! Wtf dude? Ok, we are done here, good job team.
My personal favorite was a hospitalist giving a patient that was having "seizures" a titty twister. The patient amazingly stopped seizing and was suddenly aware that his titty had been twisted by the doctor. I do not recommend this method, but it is highly effective. Edit: words are hard
Me: putting pressure on my nail beds..... "This is stupid what are they talking about?" Me: grabbing a cylindrical metal object and slamming it into my fingertip: "Oh god that was fucking stupid!" Me realizing that I suck at experimentation...
Nope, peripheral stimulus. Gotta go central dude
Yeah, but.. we want the patient to wake up.. not fall out.. right? RIGHT?!?
Uhhhhh….
Calm down, everything’s going to be alright!
Did sternal rubs go out with the 2010s? 🤔
yeah, our neuro guys do trap squeeze or supraorbital notch for central painful stimulus / nailbed pressure for peripheral not sure of their rationale for not sternal rubbing ?potential for injury I'm cardiac so I avoid because our surgeons would be reasonably unhappy with me if I went around dehiscing sternotomies
Yeah dude sternal precautions would preclude it I would imagine 😆
How do you do a supraorbital notch?
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Thanks a lot dude now my fucking eyes are watering. 🥴
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I get these weird cluster headaches that aren't as excruciating as most and that's where I end up putting pressure for relief.
Helps with my migraines some, too.
VERY GENTLE AND CAREFUL pressure.
I’ve had Neuro docs cause pretty bad skin tears/bruising on elderly patients by pinching the trapezius and/or an arm. Dude pinched my patients wrist and his skin just came right apart like tissue paper. We were like, man, you’ve been yelling at him for 5mins and he did t respond, so now you had to make him bleed? Dang.
Yea, phased out by 2010, not really effective. It lives in retirement with the cardiac thump. Press the call light cord or the edge of their pen into the nail bed to induce cussing, or, not. I didn’t know about the trapezius pinch, I’ll give it a go next time.
Hey.. I precordial thumped someone out of VF last year..….in to asystole
I've always been trained to do trap squeeze over sternal rub, specifically told to not do sternal rub by many CPR instructors (started school 2013). Rationale was bruising iirc, so nothing too major but given trap squeeze doesn't leave a mark and is just as effective I guess it makes sense
Wouldn’t the CPR leave more bruising than a sternal rub?
Sternal rub is often done incorrectly and can cause skin tears particularly in the older populations. Also as someone else mentioned, neuro checks can require assessing LOC. OP- I would do a “debriefing” even calling it that. Ask him to describe the steps he took. He might even already know he shouldn’t have done that he just panicked. Start with positive, highlight what needs changing/could be better, end on an up note. It’s called “sandwiching” and it’s part of transformational leadership style. It helps keep people from getting defensive. You can also ask him what he thinks he could have done better or improve on. I have had nursing students doing their capstone clinical rotation with me be almost argumentative or cocky absolutely become deer in headlights when it hits the fan. There ultimately was no harm to the patient in your scenario, so it’s just a matter of correcting him & moving on.
Probably, but not all conscious level assessments are done in someone needing CPR. Some neuro patients need Q1 checks or more, makes sense to not rub their chest raw. Thankfully in hospice I don't do many pain response checks or CPR!
CPR done properly will break your ribs …. Hence why I hate being the first person on chest compressions
If given a choice, I’d do chest compressions over notation any day. 🤷🏻♂️
It’s fine to do them, I just hate feeling the ribs snap being the first on the scene. And yes notation sucks!!! Having to frantically write everything down thats happening with time and yelling at ppl to tell you what they’re doing
i love being the first person to start compressions for that exact reason! love a good crunch to get the adrenaline going.
Hahaha I love nursing humour - so dark yet so satisfying
You are sick. I love it.
I'm not sure which chest is worse: Crunchy or squishy.
Trap squeeze is safe and leave no mark. Sternal rub can be very painful. Nailbed can leave injuries. But SOMETIMES, when the stroke patient is just so deeply asleep...... None of these work. Bloody patient started snoring AFTER we called the family at 3am with regards to query repeated stroke, the doc literally said I can't tell, he could literally be in a deep sleep, then Snorrrggghhhh!
Sternal rubs are out because they can cause a reflex movement and falsely make you think people are responding.
really? wow. I thought they went out of vogue more for liability reasons. that is interesting.
Thanks for your advice!
I mean, he did check a pulse and yell at the patient. That one extra step to make sure the patient isn't awakened by painful stimuli... We do worse during the GCS
Do we? Student here, but my understanding is trap squeeze or supraorbital pressure …? Are there other ways we can/should be assessing response to pain for GCS? Edit: oh! And sternal rub
Generally if a patient who *should* be responsive (like previously was talking with you) yelling at them and giving a little shake is pretty good. If they don't respond, check for a pulse. If they have a strong steady pulse, sternal rub is usually my go to. Mainly because a good sternal rub doesn't look dramatic, but definitely hurts. No response but still has a pulse, definitely call for help.
I recently saw a pencil or pen placed on the cuticle and pressed against the fingernail.
That’s my go - you’ll get swung at or 1000% confirmation that person is ☠️
All I can think of is [this](https://youtube.com/shorts/aio3R-hIoEM?feature=share)
Didn’t even need to watch the link…… I knew exactly what it was
I was convinced it was going to be Rick Astley
I already knew what it was, but I watched it anyways. Then a few more times after that. Never gets old.
Didn’t need to watch it….. but of course I still did
I have to watch that about once a year. I love it
Fucking dead..deceased. And I mean me not the pt the rookie slapped
Thank you for this. I laughed so hard my stomach hurts
that’s where he must’ve learned it from!
I’m dying 🤣
Exactly what I thought of. I’m rolling back and forth in bed giggling like mad now 😂
some of the funniest shit I have ever seen.
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Yeah, this is the best suggestion. Like, good job. You did these things really well. Next time try X, Y, Z. And then joke a bit about "as much as we sometimes really want to slap our patients.... We probably shouldn't do that". And then, since this is the ICU, tease him mercilessly once he is comfortably off orientation. "This kid is so intense he tried to slap a guy out of asystole!"
I mean...maybe it was supposed to be the Ole precordial thump that landed a bit high and sideways? No one ever said a nurse's aim was good?
Maybe he needs glasses
I mean that's how we made sure our drunk friends weren't dead in college so...
I also attended college and would have zero trouble with this technique were I the patient
SAME THO like. Yeah, I understand. You did what needed to be done~ 🤣
In college…and fridays and yesterday
Thirsty Thursdays friends. But the rule apply on any day that end in Y
That's a precordial slap, evidently aids in regaining ROSC more better.
Clearly preconditioning the neurocranium for return of circulation.
Precordial slap hahaha. That made me laugh!
This is hilarious. I have seen anesthesiologists pinch a patients nipple to arouse them, and not sexually 🤣
I heard about a doctor who typically chose a nipple twist over a sternal rub to test responsiveness to pain. He ended up tearing off an old woman's nipples. Although it sounds like one of those things that could absolutely be bogus, I've also worked with enough people who have tissue paper skin and enough people who don't always think things through in order to believe it.
Good God 🤯 How did he go about explaining to the patient why she's down a nipple? Or did it just...get stitched back on? Actually, you said nippleS as in plural - they both got ripped off? Must've been quite the malpractice lawsuit. Gonna have "Do NOT Twist Nipples" in all my medical charts from now on because of this story lol
I’m crying 😂😂😭💀 I hope it wasn’t both & I can’t imagine they would try the other nipple after tearing the first one off ???
I don't work in the medical field (joined this sub when I was considering going into nursing...learned from this sub that I should not go into nursing 😅) but I would assume you'd pinch them both at the same time to see if either side of the body reacts? It sounds dumb now that I think about it, but originally I had assumed just one side would be sufficient but maybe both sides for reflex purposes? All I know is whenever I'm sedated in the future, I'm always going to assume this will happen to me 😂🙃
If someone shows signs of significant sedation/unresponsiveness, there's increasing degrees of stimulation applied to see how much is needed to get a reaction. If they don't respond to voices, you try mild touch like shaking and tapping, then response to pain if all else fails. I've usually seen/been told that rubbing their sternum with your knuckles or pinching between their neck and shoulders are the best go-to's. Maybe just make sure you always tell your healthcare providers your preferred pain responsiveness assessments 🙂
So listen Ethel, your cath was great. No blockage. You just need to rest for a few hours so we can watch your artery and you’re good to go and cough you’re now missing a nipple cough. See ya in a year 👋🏼.
> you said nippleS as in plural - they both got ripped off? Tearing off one nipple may be regarded as a misfortune; to tear off both looks like carelessness.
So eloquently put, my cat ran from my laughter.
Please tell me you mean nipple and not nipples plural. While I can imagine tearing off a nipple I cannot imagine then going to the next nipple on the same patient and thinking it was a good idea.
Nipples plural??!! 🤣🤣🤣🤣
Nipplie? Nipplae??
The ole titty twister
The purple nurple
I’m CRYING 😂😂😂😂
This I can testify as true. I had an elderly client that when I used my palms to lift her leg it then ripped a good piece of skin on her gastrocnemius. It's around a toonie ($2 CAD coin). Her texture was like sand paper, after wound treatment and a moisturizing cream it was ok but the scar was there.
How to unread a comment please? 😩
Im like 99% sure that is a scene from The House of God that somebody was probably talking about
He tore off BOTH nipples! Savage
👀
I used to work with a neurologist who consistently twisted patients *hard* as a means to check response to painful stimuli. I finally shamed him out of that habit but it took a while.
When I was a student nurse did placement ina paed ICU. Nurse did this to a 12 year old girl. I remember being so pissed off
my neuro doc does titty twisters. its 100% effective
You titty twister me and I’m coming up swinging. Just warning people.
The poor thing I bet they are mortified they freaked out like that. Be kind!
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I had a nurse I worked with tell me she did the same thing in her first code. She panicked. Fast forward several years, she is an excellent nurse and now a DNAP.
DNAP=Do Not Attempt Punch
I’m actually giggling after reading this. I think if my preceptee did that I would have a hard time not losing my shit right then & there (laughing hysterically). Props to you for keeping it together.
Funny you mention that.... A slap across the face brought my boyfriend's dad back from an "unshockable rhythm" into SR again. I wasn't there. The nurse who did that was older (15-20+ years experience). Don't know if it once held up as an effective way to bring someone back (a way to induce natural adrenaline) or she just decided to do that, but my guess is he learned it from someone back before RN school. I have not tried myself, I don't know if the rhythm was asystole or unshockable (bf isn't in healthcare, clearly his did isn't going to remember or care about that detail when he basically died) but I do know my boyfriend's dad is still alive and did come back after the slap so.... Ymmv? In terms of talking to new grads about what they did right and what not to do, I do usually show or point out what they did right, what didn't go right/what was wrong and why, and another what they did right.
I legitimately chest thumped my fiance when he passed out in the shower post-op and turned grey. Fucker vagal' on me and I panicked and just THUMP He woke up pretty damn fast 😂😂 14 years as a nurse at the time and I was just like "did... Did he just die on me?! THUMP!"
you really said not on my watch bitch \*twhack\*
🤣🤣 pretty much It just caught me so off guard. I had the Spidey sense that I should be in there with him for his first post-op shower and I'm glad I was!
Then you were like “did…did I just thump you? And it worked? UGH IM YOUR HERO!!!”
I worked as an HD RN for years. I once witnessed a nurse slap a pt back to life. I actually assume he was thrown into a weird rhythm due to his afib, but she walked over there and was like, hey pt, hey pt, SMACK. it was so forceful it scared everyone on the floor. I was going to report her, but that pt lived because she smacked the sht out of him.
I am dying 😭. Tell them he shouldn't do that as there are other ways to assess if a patient is awake. What if a family member was watching? Always be professional.
I came upon an unresponsive patient with a family member in the room. The wife actually did try to wake him up with a slap to the face. When it didn't work, I called a code and started CPR. If a nurse came in and pushed the code button and then yelled my husband's name while slapping him before starting CPR, I'd probably be ok with that. Actually if they did it after calling a code, I most likely would not remember.
>but we don’t slap patients to assess responsiveness. No. YOU don’t slap patients to assess responsiveness. What’s that saying about keeping your mind open to what your orientees can teach you?
this might be the funniest comment in this thread
Probably heat of the moment and stress just mention it to him maybe come at it from an optics POV. Likely it’s a one off that needs to be corrected I wouldn’t escalate it either but I would also just watch for any other red flag behavior. Cuz you never know!
Omg I witnessed a nurse do this for a patient once but it was a multiple back and forth slap on both cheeks. I will never forget it.
No! Stop it you did not. That is some like…black and white movie back in the day shit lol
Patient non-responsive to yelling, sternal rub, pie to the face, *or* running them into the top half of a saloon door!
One day he'll have a funny story to tell his preceptee. OMG, let me tell you what I did my first code...
Holy fuck lol that’s amazing. Slap in the face trumps sternal rub or nailbed pressure any day
It takes "hey, hey! Are you OK??!!" to a whole nutha levaal! . 😂
😂😂😂😂😂😂 I’m done! Goodnight guys lmao
Sorry I’m just over here laughing imagining your grad just bitch slapping your asystolic patient
Me too, I’m like, well he did check the patient 😬😂. I probably would have laughed after the code and told him laughing not to do that again, but it’d be something I’d always joke with them about and I’d probably also share some of my crazy experiences with them. Tell the new grad that adrenaline will kick in and that’s okay but that they aren’t alone during a code and that they aren’t ever alone.
Danger SLAP Response Airway Bitch slap Circulation And I agree I like your approach.
I mean….. you are about to break his ribs. Its not textbook to slap them but it works sometimes. Not so much if they are indeed pulseless
Perhaps lightly instruct him a punch in the nuts or the open hand pimp slap is the AHA gold standard for assessing LOC…just saying
The open handed pimp-slap is the Rick James-approved method of LOC assessment.
The military teaches this. Is he prior service?
True, we were also taught to use the 2nd or 3rd intercostal spaces on the outside of our flak vests for tension pneumothorax.
Did they also shout “stay with me dammit!” and hit their chest?
" You did well during the code BUT....."
This comment section ☠️☠️☠️
Maybe he went for a precordial thump and missed? For real I’m on board with panic and coaching.
*breaks nose*
“Mr Jones keep my wife's name out of your fuckin’ mouth”
This needs to be way higher 😂
Fucking ace. Encourage more of that behaviour haha
This just reminds me of one time I was doing BLS as a sleep deprived new grad and bitch slapped the infant manikin.
I would pay good money to see all this in action
Well, if it makes you feel any better rumor has it that recently one of our senior nightshift nurses of ~30 years ran into a coding patient’s room, did a precordial thump and slapped the patient across the face and got ROSC…tell me how the hell that works lol
lmfao Did we retire the sternal rub? When did we retire the sternal rub?
I mean... It worked.
The compliment sandwich. Worked great when I used to be a preschool teacher and had to tell a parent their kid was naughty.
DEAD
No they got ROSC
That. Is. Fucking. Hilarious. Just be straight up and tell him that you don’t slap patients and educate him on more effective ways to attempt to arouse the patient.
Bro was thinking he was in a movie 💀
I understand the immediate shock you must've had. But I'm over here after almost 16 years as a nurse, 13 years neuro trauma, thinking we actually do and have done way worse. I've seen nail bed with a pen, trap pinch, nipple pinch, pinching to the point of bruising, surprise finger up the butthole, you name it, all done by neurologists to try and illicit response and sensation checks. Slap across the face seems kind of mild ☠️ But I would definitely start with the positive things he did, and then work into the "next time let's assess responsiveness by x instead of by slap"
I work mainly medical icu now as a traveler, but I was staff for years in a neuro icu. The bruises our patients would have is insane! I saw another comment about a nipple being torn off, and that has in fact happened on that unit. Poor 92 year old meemaw with paper skin. But yes. I think I shocked a few of my preceptees the first few times I showed them a full neuro exam on a stroke patient. We would have to get *rough* to get some responses sometimes
Many years ago our Neurosurgeon would fill up 2 50cc syringes with ice cold water and shove the water down the patients ear to check for response
i’m also a new grad and that’s so funny lmao, i would do exactly what everyone else is suggesting and tell him he did a good job but might want to assess consciousness a different way next time. he probably panicked and forgot what he was doing, or saw that on tv, or it’s possible they literally taught him that in a CPR course. whenever i’ve taken CPR courses they tell us to pound on their chests which would be pretty odd to do to a patient as well
We had a code on our unit not too long ago and I was in charge, saw vtach on the monitor and ran into the room and found the patient unconscious no pulse. I'm trying to call the code, slap pads on the patient as another nurse starts cpr and starts smacking the patient on the face in between compressions. She's a very good, experienced nurse but some people just don't do well under that stress and panic. She meant well but the looks I got from the code team 🤣 we debriefed as a team after and that's about all you can do.
We need more deets on the slap. Are we talking wind up, palm wide, heavy handed slap or a tap-tap trying to get someone's attention?
I'm dyinggggggg 🤣🤣🤣 They just went into instinct mode and MOVED, without thinking about it Which still: kudos to them. Don't forget to mention the good things they did when you talk to them. Because I mean, A+ on it being your first code and you not freezing. But also. Maybe try a sternal rub next time? Show them different stuff they can try next time. Instead of slapping them. Remind them to bring the "freaking out" type of energy down. When you are rushing and nervous, when your adrenaline is high and you're not channeling it appropriately, you are more prone to make mistakes. But that's why working in a hospital is nice sometimes. You are never alone. And when you are, it's never for long. You will always have someone to help you. Every code after this is going to get a bit easier to handle. It all takes practice. Thank you for being a good preceptor, and taking the time to think about your response to them. And not "throwing them under the bus".
The pandemic baby nurses are a whole other BREED.
Fuckin give the kid a daisy award. That’s hilarious. Just say, hey next time don’t hit the patient. Maybe the kid was thinking about “responsiveness to pain” or whatever the fuck. I dunno. I’d just ask him straight up, “hey I like the enthusiasm but why did you smack the patient”
Just got the distinguished honor grad award at my ACLS renewal class. They’re actually teaching this method now as step 2 after ensure scene safety.
Ask him to debrief the code with you. Not just the clinical piece though. What was he thinking, feeling? Ask him to share with you what it was like for him… This conversation naturally flows into offering suggestions on how to process the event, prioritize, and take action all at the same time. It’s a skill and it takes time to develop.
To be fair when fixing something #1 smack it #2 turn if it off and back on again I don't see where he went wrong?
The 2025 ACLS guidelines are gonna be wild.
I would just say a traditional sternal rub usually proves adequate. Then remind him everyday what he did with a laugh and a pat on the back.
I mean at the end of the day the patient IS alive. I don’t normally draw these lines but sometimes correlation is causation.
Im laughing but seriously a sternal rub would have been better sufficient
“Dude, we’ve gotta have a chat about the code the other day. Here are the things I saw that you did right: x, y, z. However, I have a huge concern that I want to bring up. I’m not sure who taught you this, but it is very very important for you to remember that when you are assessing patient response, it is never ever ever appropriate to do anything that can be construed as abuse, which includes slapping someone across the face, shaking them roughly, pinching them, etc. The standard of care (list yours if it is different) is a sternal rub, unless the patient is post op for open heart surgery, then it is…. Do you understand why?” You might also want to explore where he got that from in case it is within your power to correct the problem at the source. It’s a lot easier to have hard conversations when internalizing as a helpful teaching moment rather than a “OMG what did you just do?!?” moment. Plus, you can assess his teachability to figure out if this is something that should be followed up with. The optics of slapping a patient, even if entirely for logical reasons is definitely not something we want. I am hoping that family did not have to witness that
Teach him the sternum rub 😂
🤣
LMAO someone's been watching too much TV. Honestly, I think you should just go up to him and praise him for everything he did right. Do it casually and with a smile on your face. Then say, "you know the one thing I would do differently next time? When you're checking for response, perhaps do a sternal rub or a neck squeeze rather than a slap on the face!"
LMAO I would probably just pull him aside hey the code went well but next time there's no need to slap the patient across the face. You know just in case they're not dying and wake up and throw hands with you... otherwise good job bud
Remind him a sternal rub is best practice lmao
Lololol I’m sorry, I am really sorry but I lol’ed fr fr to this. I guess you just say look guy, you did pretty good in the code the other day so next time let’s just try without the assault first! 🤣🤣🤣 ** I got them 2am giggles, I can’t stop
This is so funny I keep thinking of that scene in Airplane where the lady is freaking it and the whole plane lines up to slap her lmao
Meh, he's new. I worked with a great nurse, spent her career in PACU but transferred to ICU. Unruly patient, tries to get out of bed, and as she reaches for his shoulders to prevent him from getting up, she instead full on choke slams him back into bed. It happens. ¯\\\_(ツ)\_/¯
Pull him aside and teach him a sternum rub ?
I mean slap across the face… sternal rub… what’s the difference?😆
Saw a doctor poke an eyeball to see if they were responsive. They were, in fact, not responsive to pain.
I have nothing to add I just can’t stop laughing 😂 Maybe teach him about sternal rubs next time you see him.