[ELKMNin06]

Originally Posted by neurogeek

I said it was typically viewed as more central. I didn't say it was used to test GCS. Where I've worked we always use either trap or supraorbital. We only use the skin pinchs if none of the other illicit any movement. It's for those time you really have to get down there & see if ANYTHING flinches at all. GCS movement is the best movement seen, whether it's upper or lower. The official scoring of best motor is:
6 = can obey command
5 = can localize stimuli and try to remove it (can't do that with a foot, has to be a hand crossing the midline to count)
4 = purposeless movement with response to pain
3 = flexion (flexes elbows & wrists while extending legs) or decorticate
2 = extends upper & lower extremities to pain or decerebrate
1 = no motor response

So, if your patient has no motor response with UE's to pain but extends LE's then you would score them a 2. This is with central stimulus. So, yes, you do score by LE movement.

Our GCS works a bit different than yours. We dont use LE at all to score a GCS. When I get to work tonight ill let you know word for word how ours is scored as i dont want to misstate

So my question was and still is: when you illicit a response from the thigh pinch do you watch for the response in the UE or LE? SOrry I just havent heard of this teq. before. I have a hard time the trap pinch as I can never seem to get a response when I use it.

[ELKMNin06]

Originally Posted by neurogeek

By the way, where do you work where there are 55 Neuro ICU beds? That must be some place! Are they all critical care, or are some of them step-down beds? Are they divided by trauma vs surgical, etc.? Just wondering. My facility is beefing up our whole neuroscience dept. and adding many more beds (already have over 25) and adding a new floor for step-down that will take vents. I'm the coordinator for the whole program so I always welcome new info about other units.

Lets see here. On my side of the floor we have 36 neuro ICU beds. Then we have another side that has 16 more neuro ICU beds. THen we have about 8-10 neuro ICU overflow beds.

We don't have step down per se. My facility doesnt like using the word step down but neuro med-surg instead. Our stepdown beds dont take vents or drains. We have 2 neuro-medsurg (only neuro pts though) floors and id guess about 60 beds...we also have neuro-tele where just neuro pts with cardio issues go after the ICU. We also have a brand new in pt. neuro rehab that id say is prob somewhere around 30-35 beds, maybe more, not positive on that one.

I work in the Barrow Neuro. Institute in Phoenix. We are in SJHMC. The rest of the hospital has all your other flloors, L&D, Peds, PICU, NyICU, CICU, MICU, SICU, MS, Heart and LUng institute, etc. We are a huge hospital but I love it. We are completely neuro obsessed. LOL. We get pts from all over the world, it can be insane at times.

[smartynurse]

Originally Posted by teeituptom

Well even further back in the old days, they used to twist nipples to check for response. Primarily on women of course. Saw that done all the time decades ago.

Still was being done at the trauma unit I worked in in Baltimore 12 years ago!

[janfrn]

Originally Posted by smartynurse

Still was being done at the trauma unit I worked in in Baltimore 12 years ago!

Still being done in the CCU here in Edmonton... my best friend's husband arrested in a hot tub at the Y back in February and when they were assessing his recovery potential, the neurologist gave his nipple a pretty vicious twist. When my friend saw that she nearly passed out... she who has worked CCU and PICU for two decades. But she was more distraught by the fact that he didn't react to that assault in any way... and he died a couple of days later.

[jill48]

Originally Posted by teeituptom

Well even further back in the old days, they used to twist nipples to check for response. Primarily on women of course. Saw that done all the time decades ago.

OWWWWWWWWW!

[neurogeek]

HATE the nipple twist. I can imagine seeing it done on a family member would be pretty traumatic. Typically the GCS just says flexion or extension on 3 & 2 of motor, and doesnt' elaborate. But the true definition of those as per the original protocol includes LE movement. So even if your GCS doesn't specifically say this, that is what it means. A good resource is "The Clinical Practice of Neurological and Neurosurgical Nursing" 5th edition by Joanne V. Hickey. If you've never read her book I highly recommend it. The is THE neuro guru of all time. I've met her and she's a lovely, talented, SMART woman. Anyway, I came in this morning and read these emails. So I pulled her book to see what she has to say, and on page 165 she clearly defines the GCS as including LE's. If in doubt, always refer to her book. The CNRN (does anyone else have there's?) uses this guideline on their test. I remember when I took my certification YEARS AND YEARS ago (I am so getting old!), one of the questions on my test was about LE movement when checking the GCS. I don't remember the scenario but clearly remember that with stimuli my patient had LE movement only and I had to give the pt. a GCS score. Anyway, trust Hickey for accurate information.

[BBFRN]

Originally Posted by neurogeek

Trap is good, periorbital is fantastic. Especially for pseudo-seizure pt's.

Thank you for pointing this out. I had another nurse act like I was being mean for doing this when I was a charge nurse, and pt had a pseudo-seizure every time her nurse tried to d/c her home. The pt had already learned how to withstand everything else (arm drop, etc). She didn't expect a periorbital, and I got a definite response from it. Of course, several weeks later, and after many trips to the ICU for "seizures," everyone was in consensus that she was having pseudo-seizures.

[janfrn]

When determining what type of posture a person is exhibiting, the LE movements are the same, extension, but there is movement. The UE flexion/extension and internal rotation is the definitive. Extensor posture is always BAD!

[all4schwa]

When is it that you are applying the orbital pressure during the psuedo seizure, during or after?

[LadyNASDAQ]

We do a hand clap loudly to each ear. It isn't painful but will give you the startle response you need. After, check if patient is moving their eyes and pupillary response.

I was taught no nailbed pressure or nipple twists ever. Light sternal rub but what works better is cold fingers to the neck. If that doesn't give a response, stop right there.