Test For Unconsciousness: The Sternal Rub

Ahhh the embattled sternal rub. Revered, reviled … the sternal rub is the Ann Coulter of medical interventions. Abrasive, annoying, loved by many, hated by many more. The subject of the usefulness of the sternal rub is bound to cause controversy in any EMS forum.

In other words … it’s a great subject for The Spot.

Like many controversial assessments and treatments, the sternal rub (sometimes referred to as the sternum rub) got its bad-boy reputation more from its misuse than from its own shortcomings. Never-the-less, the technique does have its shortcomings.

Like so many other tools, it has its place when used appropriately and it has its potential for misuse. So let’s make sure you understand its uses and limitations.

If you’ve never encountered this technique, the sternal rub is a test for unconsciousness. It’s a popular form of painful or noxious stimuli designed to illicit a response from a conscious or semi-conscious person. Establishing an unresponsive patients ability to respond and remove noxious stimuli is perfectly medically appropriate.

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How To Make Sure Your Hand-off Reoprt Gets Heard

“But … It Was In My Hand-off Report“

Every EMS responder who delivers patients to the emergency room has experienced the frustration of feeling like the ED staff didn’t really get the whole picture. You came in, you told the story and you said your goodbyes, but somewhere along the way it felt like there was a disconnect.

Now, some excellent research out of Harvard tells us exactly how much of the EMS hand-off report is really making it into the patients chart and being used in the clinical decision making and care of the patient. I’m sure the study findings are going to have a bit of a “duh” effect on responders who give routine hand-off reports to ER staff, but it is nice to feel that your impressions have been validated by some objective measure.

Researchers decided on 16 prehospital data points that were considered to be significant in effecting patient outcomes in level one trauma activations. Then they had a panel of trauma physicians watch videos of the EMT-to-trauma-team hand-off reports and checked off when the data points were actually communicated in the verbal hand-off report. Next they checked the patients medical record to see how many of these data points had been recorded in the patients chart.

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Treatment of Head Injury

Part three of a three part series

In our last two installments we looked at the way heads get injured and the various ways the brain tends to bleed. In this, our last installment in the head injury series, let’s take a look at basic treatment and management of the head injury patient.

There are a lot of variables that need to be considered when managing a head injury patient in the prehospital environment. Your treatment will be guided by considerations like the mechanism and severity of the head injury, other associated injuries, the patients mental status and their basic stability. 

These are some guidelines when sizing up and prioritizing your care.

Airway Management:

Head trauma management begins with the airway. The brain is sensitive to hypoxia and a poorly managed airway can turn a significant but recoverable head injury into a devastating head injury. Our brain injured patients can present some unique airway challenges. Seizures and posturing can produce trismus and spinal precautions prohibit proper tilting of the head.

In these cases, oral and nasal airway adjuncts are helpful in ensuring proper ventilation while keeping the head midline and neutral. If the Glasgow is less than eight, consider an advanced airway like a king tube, combi-tube or ET tube. All of these should be protected from the possibility of a clenched jaw with some sort of bite block type protection.

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