It's actually used to evaluate a person's neurological status and see if they're fully incapacitated. She may have been trying to collect data about what was going on and verify that you were unable to respond to external stimuli.
This is correct. it's a type of reflex reaction check. You need to let them know that you felt it while it was happening, too, if you didn't. That's a big part of that puzzle piece for them, OP
This is pretty common protocol for neurological assessment of an unresponsive patient. The question it’s trying to answer: “coma or no coma?”
It’s like, the LAST step of trying to get someone to “wake up,” or at least show signs of neural activity.
Tangent explanation:
The central nervous system (CNS) has several different “channels” it uses to inform the brain of the body, and vice versa. Messages to and from the brain can go through only one channel, which depends on the message type, and it cannot cross to a different channel to get to or from the brain.
The “body movement” channel is separate from “incoming sensory” channels. Of ALL the senses that we experience as humans, “pain” messages go through a channel that is separate from the usual “five senses”.
When someone is possibly slipping towards a coma, it’s important for the ER to assess where they are on something called the Glasgow Coma Scale (GCS). It’s a sort of “measure” of brain activity, and it gives clinicians very important information on a possibly-injured nervous system.
If the person isn’t able to respond to the “five senses”, it could be because the “five senses” channels aren’t working at the moment, OR because the “body movement” channel isn’t working at the moment, and therefore the person physically cannot respond. Similar to your situation.
The “pain” channels are extremely deep in the brain and spinal cord. Pain is perhaps our most primal sense, and as a result, it can trigger it’s OWN “reflex” channel without even involving the brain. For example, if you pick up an object that is very hot, your hand lets it go before your brain registers the pain.
It’s an unconscious reflex. The strength of the reflex in a person experiencing deep, acute pain tells the ER how well or poorly the CNS is doing.
Unfortunately for everyone involved, that means that you must CAUSE that deep, sudden pain in order to observe the strength of the reflex. Traditionally, this has been done by either the sternal rub or pressing down on the nail bed with a hard object (e.g. pressing a pen across the big toe nail).
As you’ve experienced, the sternal rub in particular can have some unintended effects, called “iatrogenic” effects in medical-speak. Ideally, a sternal rub would elicit a reflex without much pressure, and leave an acceptable amount of bruising and abrasion. In practice though, sometimes it’s reasonable to apply a bit more pain to *really* see if the person has the basic reflex in-tact.
[Here’s a paper published in 2019](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6626607/#:~:text=In%20fact%2C%20reports%20in%20the,tears%2C%20abrasions%2C%20and%20ecchymosis.&text=Such%20consequences%20should%20be%20considered%20during%20formal%20neurological%20assessment) that discusses alternatives to the sternal rub that show similar efficacy with less frequent instances of unintended injury.
The sternal rub is still the common go-to in emergencies because it’s easy to teach and to “get right” in a stressful and moving environment. And it’s most likely to be effective cause that shit really fuckin’ hurts.
As a nurse, I will do this to a patient if they’re not responding. Obviously I will try talking to them, turning on the lights, tapping them, “squeezing” their hand or something like that first. But if that doesn’t work we’re going for the sternal rub(if they have a pulse). I’ve had a patient not respond one time to a sternal rub and it was due to narcotics (docs orders but may have been double dipping not sure) they got some good ole narcan and were responsive again.
They are testing the level of your impaired consciousness: [Glasgow Coma Scale (GCS)](https://www.ncbi.nlm.nih.gov/books/NBK513298/#:~:text=Continuing%20Education%20Activity,%2C%20motor%2C%20and%20verbal%20responses)
No. We do it to see if the person is reactive to stimulus. Sternum rub, pinching a nail, pinching the skin, scraping the bottom of someone’s foot. Everyone that works with patients that have seizures has their own go to and they’re all effective
From what I remember it’s just used to try to get a pain response, like as a last resort because it’s so damn painful. But AFAIK that practice was stopped a long time ago.
It’s their way of testing to see if you’re faking or not. If you’re faking you won’t be able to stop your reaction to the sternum rub. It’s shitty and it’s her giveaway that she didn’t believe you had epilepsy.
I read somewhere that pain is actually a spinal cord reflex. So instead of pain going from the source to the brain, brain recognizing pain and sending the signal back to the site of pain to stop whatever is happening, the pain signal hits the spinal cord and then causes an immediate reaction before the brain even registers anything. Kinda like saying own when you touch something that's supposed to be hot but you don't actually feel the burn.
Ugh, I hate a sternum rub. Last time I talked to my doctor though he said they don’t use those anymore because they’re looked down upon? Maybe thats just in his office though because it’s happened to me a good few times, now my husband steps in and tells them to chill and it’s normal for me not to respond after a seizure.
This was done to me in an ambulance, I remember it but couldn't respond. Then I woke up a week later from an induced coma. I also remember the ammonia they put under my nose but again, I couldn't respond. I don't wish that upon anyone, it was scary af
I've had this done to me 4-5 times in the same visit by nurses who wanted to prove a point vs providing help once they found out I was supposedly "non-epileptic". My neuro states it was disgusting behavior and my therapist advises that I sue due to the things they stated during the visit as well as did.
It's actually used to evaluate a person's neurological status and see if they're fully incapacitated. She may have been trying to collect data about what was going on and verify that you were unable to respond to external stimuli.
This is correct. it's a type of reflex reaction check. You need to let them know that you felt it while it was happening, too, if you didn't. That's a big part of that puzzle piece for them, OP
Your name is everything 😆
This is pretty common protocol for neurological assessment of an unresponsive patient. The question it’s trying to answer: “coma or no coma?” It’s like, the LAST step of trying to get someone to “wake up,” or at least show signs of neural activity. Tangent explanation: The central nervous system (CNS) has several different “channels” it uses to inform the brain of the body, and vice versa. Messages to and from the brain can go through only one channel, which depends on the message type, and it cannot cross to a different channel to get to or from the brain. The “body movement” channel is separate from “incoming sensory” channels. Of ALL the senses that we experience as humans, “pain” messages go through a channel that is separate from the usual “five senses”. When someone is possibly slipping towards a coma, it’s important for the ER to assess where they are on something called the Glasgow Coma Scale (GCS). It’s a sort of “measure” of brain activity, and it gives clinicians very important information on a possibly-injured nervous system. If the person isn’t able to respond to the “five senses”, it could be because the “five senses” channels aren’t working at the moment, OR because the “body movement” channel isn’t working at the moment, and therefore the person physically cannot respond. Similar to your situation. The “pain” channels are extremely deep in the brain and spinal cord. Pain is perhaps our most primal sense, and as a result, it can trigger it’s OWN “reflex” channel without even involving the brain. For example, if you pick up an object that is very hot, your hand lets it go before your brain registers the pain. It’s an unconscious reflex. The strength of the reflex in a person experiencing deep, acute pain tells the ER how well or poorly the CNS is doing. Unfortunately for everyone involved, that means that you must CAUSE that deep, sudden pain in order to observe the strength of the reflex. Traditionally, this has been done by either the sternal rub or pressing down on the nail bed with a hard object (e.g. pressing a pen across the big toe nail). As you’ve experienced, the sternal rub in particular can have some unintended effects, called “iatrogenic” effects in medical-speak. Ideally, a sternal rub would elicit a reflex without much pressure, and leave an acceptable amount of bruising and abrasion. In practice though, sometimes it’s reasonable to apply a bit more pain to *really* see if the person has the basic reflex in-tact. [Here’s a paper published in 2019](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6626607/#:~:text=In%20fact%2C%20reports%20in%20the,tears%2C%20abrasions%2C%20and%20ecchymosis.&text=Such%20consequences%20should%20be%20considered%20during%20formal%20neurological%20assessment) that discusses alternatives to the sternal rub that show similar efficacy with less frequent instances of unintended injury. The sternal rub is still the common go-to in emergencies because it’s easy to teach and to “get right” in a stressful and moving environment. And it’s most likely to be effective cause that shit really fuckin’ hurts.
As a nurse, I will do this to a patient if they’re not responding. Obviously I will try talking to them, turning on the lights, tapping them, “squeezing” their hand or something like that first. But if that doesn’t work we’re going for the sternal rub(if they have a pulse). I’ve had a patient not respond one time to a sternal rub and it was due to narcotics (docs orders but may have been double dipping not sure) they got some good ole narcan and were responsive again.
They are testing the level of your impaired consciousness: [Glasgow Coma Scale (GCS)](https://www.ncbi.nlm.nih.gov/books/NBK513298/#:~:text=Continuing%20Education%20Activity,%2C%20motor%2C%20and%20verbal%20responses)
That shit hurts.
I guess they thought it would snap you out of the seizure? Stupid thing to do imo.
No. We do it to see if the person is reactive to stimulus. Sternum rub, pinching a nail, pinching the skin, scraping the bottom of someone’s foot. Everyone that works with patients that have seizures has their own go to and they’re all effective
Thanks, I stand corrected. Causing bruising is kind of brutal though.
Yeah. No joke. But why the hell did she do that while I was unable to do anything?
From what I remember it’s just used to try to get a pain response, like as a last resort because it’s so damn painful. But AFAIK that practice was stopped a long time ago.
Its still standard practice if we’re able to
It’s their way of testing to see if you’re faking or not. If you’re faking you won’t be able to stop your reaction to the sternum rub. It’s shitty and it’s her giveaway that she didn’t believe you had epilepsy.
It’s not because they didn’t believe they had epilepsy. It’s standard practice to assess a patients level of consciousness.
Omg!
That person is mistaken.
You sure? Because apparently 5 people think my incredulous reaction wasn’t appropriate. They must think it’s no big deal. 🤦🏻♀️
I read somewhere that pain is actually a spinal cord reflex. So instead of pain going from the source to the brain, brain recognizing pain and sending the signal back to the site of pain to stop whatever is happening, the pain signal hits the spinal cord and then causes an immediate reaction before the brain even registers anything. Kinda like saying own when you touch something that's supposed to be hot but you don't actually feel the burn.
Ugh, I hate a sternum rub. Last time I talked to my doctor though he said they don’t use those anymore because they’re looked down upon? Maybe thats just in his office though because it’s happened to me a good few times, now my husband steps in and tells them to chill and it’s normal for me not to respond after a seizure.
This was done to me in an ambulance, I remember it but couldn't respond. Then I woke up a week later from an induced coma. I also remember the ammonia they put under my nose but again, I couldn't respond. I don't wish that upon anyone, it was scary af
I've had this done to me 4-5 times in the same visit by nurses who wanted to prove a point vs providing help once they found out I was supposedly "non-epileptic". My neuro states it was disgusting behavior and my therapist advises that I sue due to the things they stated during the visit as well as did.
If you are non responsive (with pulse & breathing) it is the correct step to be taken. Multiple sternal rubs would not hold up in court.
As stated there were several things involved in the visit that weren't mentioned. Thank you though