What Is A Sternal Rub?

A sternal rub is a medical procedure used to assess the responsiveness of an unconscious or unresponsive person. It involves applying firm pressure to the sternum, or the flat bone in the middle of the chest, using the knuckles of a closed fist. This action creates a painful stimulus meant to provoke a response from the patient.

The sternal rub is a crucial method in assessing a patient's level of consciousness and promoting breathing. It is often used when someone is unresponsive to gentler attempts at interaction, such as talking or gentle touch. The procedure is particularly useful when someone loses consciousness due to a brain injury or an overdose.

The sternal rub technique involves rubbing the sternum vigorously with your knuckles while closing your fist. If the patient doesn't respond within a few seconds, it can be concluded that they're unresponsive and their brain might not be functioning properly. However, some patients may need up to 30 seconds of continuous sternum rub to respond.

The sternal rub is used to assess cardiac function, indicate the level of consciousness, check for pain response, evaluate neurological function, assess the severity of emergency situations, and it is a non-invasive method of assessing a patient's condition.To perform a sternal rub, you should first examine the sternum and avoid rubbing if there's any recent surgery or injury in the area.

Then, make a tight fist and rub your knuckles firmly up and down the person's sternum with controlled pressure. Continue the rub with consistent pressure until the person responds, limiting the rub time to 30 seconds. Finally, observe for any reaction, which could be a slight movement of the hands or feet, indicating a response to the stimulation.

However, there are instances where a sternal rub should be avoided. These include when dealing with intoxicated or sedated patients, when the patient has had recent open heart surgery, or when the patient has severe injuries or suspected rib fractures.It's also important to note that the sternal rub is not the only method to apply a painful stimulus. Other methods include a trapezius pinch and supraorbital pressure.

Misinterpretation of the results of a sternal rub can occur, especially if the pressure is not applied for a sufficient length of time. It's important to apply the sternal rub for up to 30 seconds to ensure an accurate assessment of the patient's responsiveness.

In conclusion, a sternal rub is a valuable technique in medical emergencies to assess a patient's level of consciousness and responsiveness. However, it should be used with caution and only when necessary, considering its potential to cause pain and discomfort to the patient.

Featured Answers

A sternum rub is a medical procedure in which the knuckles of a closed fist are used to apply pressure and cause pain at the center of the chest plate. This procedure is used to infer the level of brain activity from a patient who is breathing but unresponsive to verbal stimulus.

Answered from CD

A sternal rub is an important medical procedure performed to assess neurological function in patients with an altered level of consciousness. This FAQ guide provides comprehensive information on what a sternal rub is, when it is performed, how to do it properly, interpretation of responses, and more.

A sternal rub, also sometimes called a sternum rub, involves applying pressure with the knuckles to the breastbone (the sternum) to stimulate pain. It is used to evaluate a person's level of consciousness, reflexes, and ability to feel and respond to a painful stimulus.

Medical professionals use sternal rubs to briefly inflict pain on patients appearing unresponsive in order to observe their reflexive reactions. These reactions provide information about current neurological status.

When are Sternal Rubs Performed?

Sternal rubs are performed when a patient exhibits an altered mental status or decreased consciousness and does not respond to normal verbal or tactile stimuli such as calling their name or light touch. Common situations requiring a sternal rub assessment include:

Head trauma and traumatic brain injuries (over 2.8 million occur annually [1])
Stroke (795,000 strokes occur in the US each year [2])
Alcohol intoxication or drug overdose (overdose deaths topped 70,000 in 2017 [3])
Medical sedation and anesthesia (100 million surgeries performed globally [4])
Seizures and post-seizure evaluations (3 million US adults affected by epilepsy [5])
Metabolic disorders like hypoglycemia
Psychiatric disturbances

Rapid neurological assessment guides appropriate medical intervention in all these cases. The sternal rub serves as a fast, effective tool to gauge neurological function.

How is a Sternal Rub Performed?

Proper sternal rub technique is important for patient safety and comfort. Here are the key steps:

Patient is positioned lying supine (on their back)
Assessor's dominant closed fist is centered over the lower half of the sternum, 2-3 finger widths below the sternal notch
Non-dominant hand placed under the back provides support
Maintain 90 degree angle as fist firmly rubs briskly back and forth over sternum for 10-15 seconds
Rub only with the knuckles, not fingertips or wrist
Apply enough pressure to expect a withdrawal response in a normal individual
Assess facial expressions for indications of pain perception
Note any upper extremity flexion, lower extremity extension or localization movements

Ideally, sternal rub stimulus should be applied briskly for 10-15 seconds before reassessing reactions. Proper positioning and hand placement helps avoid injury. Only sufficient pressure to elicit responses should be used to prevent complications like petechiae.

[INSERT IMAGE OF STERNAL RUB HAND POSITIONING]

Only medical professionals trained in administering sternal rubs should perform them. Improper technique could potentially fracture the sternum bone in frail patients.

What Responses Indicate an Intact Neurological System?

An appropriate response signalling intact neurological pathways is purposeful, coordinated movement of all 4 extremities demonstrating awareness of pain and reflexive motor response.

Typical reflexive reactions include:

Flexion of arms and legs to withdraw from painful stimulus
Pushing assessor's hands away in attempt to localize pain
Moving arms in toward chest at the site of stimulation
Moaning, groaning or vocalizations
Facial grimacing
Opening eyes
Increased heart rate and respiratory rate

Localized, purposeful reactions as opposed to generalized, undirected movements demonstrate awareness and neurologically appropriate pain responses.

Even minimal reactions provide some indication of intact pathways. Subtle responses like increased heart rate may still occur with impaired consciousness.

What does the Response Indicate about Level of Consciousness?

The strength and coordination of motor responses provides information about the patient's current level of consciousness and neurological function.

Assessment is based on the Glasgow Coma Scale (GCS) which ranks eye opening, verbal performance, and motor performance:

GCS 13-15 indicates mild brain dysfunction
GCS 9-12 indicates moderate brain dysfunction
GCS 3-8 indicates severe brain dysfunction

Purposeful coordinated movement signifies mild-moderate dysfunction. A weaker, generalized response indicates more significant neurological depression.

No reaction may demonstrate profound coma. These patients require urgent intervention to maintain airway, breathing, and circulation.

Are there Variations to Sternal Rubs?

There are a few variations to standard sternal rubs:

Supraorbital rub: Applying pressure to the eyebrow ridge and orbital bones
Digital rub: Pressing and rubbing fingernails and nail beds
Abdominal rub: Brisk, circular rubs to the abdomen

These all work on the same premise of eliciting a withdrawal reflex. However, sternal rubs tend to be the most reliable and effective.

What Precautions Should be Taken with Sternal Rubs?

While generally safe, proper precautions can minimize risks:

Assess skin integrity prior – avoid rubbing over areas of broken skin
Use only minimal effective force – no bruising or skin breakdown should occur
Take care with children, the elderly, those on anticoagulants or the frail
Cease immediately if adverse reactions noted
Monitor after for complications like petechiae

Discomfort can be managed with reassurance, numbing cream, and gentle massage after assessment.

Who Performs Sternal Rubs?

Only appropriately trained medical professionals should perform sternal rubs, including:

Doctors
Nurses
Paramedics
Physical therapists
Other clinicians assessing neurological status

With adequate training, sternal rubs can be safely and effectively performed in hospitals, pre-hospital transport, rehabilitation facilities, and conscious sedation monitoring.

How Does a Sternal Rub Assess Neurological Function?

On a cellular level, a sternal rub evaluates the reflex arc – the neural pathway allowing a reflex muscle reaction to a sensory stimulus.

[INSERT REFLEX ARC DIAGRAM]

These are the key aspects assessed:

Sensory receptors – Nociceptors that detect pain/pressure on sternum
Sensory neurons – Carry impulse to spinal cord via ascending pathways
Integration center – Processes signals in brainstem reticular activating system
Motor neurons – Propagate signals to induce muscle contraction via descending pathways
Effectors – Skeletal muscles that contract to flex or extend extremities

This reflex arc involves both sensory and motor pathways responsible for detecting pain, processing it, and coordinating a reflexive motor response. Disruption at any point could impair appropriate reaction.

Sternal rubs provide crucial insight into these neurological processes that determine arousal and consciousness. By testing reflexive responses, clinicians can discern deficiencies requiring prompt intervention.

Frequently Asked Questions

Q: Why cause a patient pain with a sternal rub?

A: The brief pain from a sternal rub is necessary to assess neurological function. The stimulus prompts an instinctive, reflexive response signaling awareness. When used properly, the discomfort is minor and temporary.

Q: What if there is no reaction to the sternal rub?

A: No reaction signifies neurological depression requiring immediate intervention. Vital signs and airway should be stabilized and causes like narcotics overdose treated urgently.

Q: Could a sternal rub injure my sternum bone?

A: When performed correctly, sternal rubs do not pose risk of fracture. Improper positioning or excess force could potentially cause injury in elderly/frail patients. Clinicians are trained to rub briskly but with a controlled pressure.

Q: How often should sternal rubs be performed?

A: Typically every 1-2 hours for altered mental status patients or those under sedation. Stimulus should be applied for 10-15 seconds at a time to adequately assess reactions.

Q: Are nail bed rubs as effective as sternal rubs?

A: Finger/nail bed stimulation can prompt some response but tends to be less reliable than sternal rubs for gauging purposeful reactions. The sternum provides a centralized site of pain to assess coordinated movement.

Conclusion

In summary, sternal rubs provide a fast, effective means of assessing neurological status in patients with altered consciousness. When performed correctly by trained clinicians, they deliver key information through testing reflexive pain responses. This FAQ guide covers proper technique, response interpretation, precautions, and more to create a comprehensive overview of this vital medical procedure. With appropriate use, the sternal rub serves as a simple but invaluable tool for gauging and protecting neurological function.

Sources

[1] https://www.cdc.gov/traumaticbraininjury/get_the_facts.html
[2] https://www.cdc.gov/stroke/facts.htm
[3] https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates
[4] https://www.cdc.gov/epilepsy/data/index.html

What Is A Sternal Rub?