[neurogeek]

When checking gag on my intubated patients I usually just move the ETT tube a bit if they don't cough with suction. The other day I saw a nurse shoving the ETT down so far I thought I'd lose sight of it! I also saw her later trying to illicit gag by using the yankeur and it too was halfway down the patients throat! When I approached her she got really defensive about it. I tried to tell her nicely that it only takes minimal stim to determine gag, and boy was she mad. I guess if you shove it far enough down and tickle their anus they'll eventually respond, huh?

[ELKMNin06]

Originally Posted by neurogeek

When checking gag on my intubated patients I usually just move the ETT tube a bit if they don't cough with suction. The other day I saw a nurse shoving the ETT down so far I thought I'd lose sight of it! I also saw her later trying to illicit gag by using the yankeur and it too was halfway down the patients throat! When I approached her she got really defensive about it. I tried to tell her nicely that it only takes minimal stim to determine gag, and boy was she mad. I guess if you shove it far enough down and tickle their anus they'll eventually respond, huh?

lol. needed a good laugh this morning:0)

I usually use the yanker if I can.

[auzzieneuronurse]

Our GCS criteria must be slightly different as if the pt does not obey commands or localise to central pain (sternal rub) we apply nailbed pressure bilaterally to elicit a withdrawl/abnormal flexion/extension response.

[neurogeek]

Originally Posted by auzzieneuronurse

Our GCS criteria must be slightly different as if the pt does not obey commands or localise to central pain (sternal rub) we apply nailbed pressure bilaterally to elicit a withdrawl/abnormal flexion/extension response.

When performing the sternal rub the patient should exhibit flexion or extension then if it's present. There is no need to do nailbed pressure. You're looking for brain reaction, not peripheral. So checking for central stimulus with nailbed pressure isn't going to give you the most accurate results. If you think about it, flexion means that there is still some function in the cerebral cortex (although VERY abnormal) and extension means that function is now in the brainstem. So you really want to assess these movements using central stimuli. Does that make any sense?

[all4schwa]

Yes, it does make sense. I knew that extension was 'worse,' but didn't really know why..thanks!

[Cissi Oloomi]

The neuro assessment is the most misunderstood assessment.
You use the central stimulus to check level of consciousness- have you tried the pinching of the ear- it is good if you can't do the others. However, you must still check movement of each extremity and if they can't voluntariy move each extremity and /or they are unable to follow verbal commands, you might need the painful stimulus.
In addition, when checking if they can squeeze your hands, if you put your two fingers on top of their fingers and not in the palm, then you won't potentially get the palmar or grasp reflex. And tell them to let go.If it is a refex, it is triggered by palmar stimulation and they won't let go.


Neuro CNS

[castens]

Originally Posted by ELKMNin06

yep. I usually use: show me two fingers (however im not even picky on which two)...I

...and when you get the "double bird" you know that they are definitely following commands (and probably ready to extubate, for that matter).

[Praiser]

Originally Posted by EmerNurse

Anyone point to a website that shows these different techniques (trap squeeze, periorbital,etc)? I do very little severe neuro so I'm not familiar.

Thanks!

Yes, I am quite interested in how these techniques are done too. Please share !
Thanks ~ Praiser