Neuro ICU - "how to test for pain response in comatose individuals

Ok I have a few more questions. I am also a new Neuro nurse here fresh out of orientation. Because nail bed pressure can show both painful stimuli response and spinal reflexes, how are we to know? Also, how to you chart on the GCS if a pt. moves their arm, leg etc to "noxious stimuli" such as suctioning and also to pain? Wouldn't the move to suctioning be higher level of functioning than pain? On our flow sheet we have a GCS and then we have spots for all 4 extremities where we chart either a muscle grade 1-5 or like PS, TS, SP, dec. decort. posturing etc. I guess I sometimes still am having a hard time with all of this and I really do want to be accurate. I also have a hard time telling the difference between localizing to stim and normal flexion withdrawl on the GCS. Can anyone explain these in further detail? Thanks so much, Abby

Janwebsa,
I work at a level 1 in South Florida and I am studying for the critical care certification. I can tell you NOT to pinch them, not to do the sternal rub and never do the suborbital pressure that some old timer MDs still do. What is taught here is the "trapezius pinch" to grab the skin over the trapezius and squeeze will ilicit the response you are looking for. In addition, I am also a former coma patient and I am thankful for nurses like yourself that try to reach out to those who are in the limbo between the living. I still remember the kind voices who spoke to me and reached for me over the distance of time and space. THANK you.