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Checking consciousness by touching the patient?

Emergency   (1,988 Views 14 Comments)
by CSUSM10 CSUSM10, RN (Member)

CSUSM10 is a RN and specializes in ER psych.

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Is it ok to touch a pt to check responsiveness?  If a patient with a triage note stating ems found them unresponsive was lying supine in a bed with a towel over the head and not responding to being called, is it ok to touch them (tap their foot) to check responsiveness? Sounds weird, i know, but there was a patient threatening to call police for assault for doing just that.

Edited by CSUSM10

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Of course it is okay. People threaten a lot of things.

Remember to maintain professionalism at all times. I have known a couple of people who thought these kinds of scenarios were invitations to be a smart-alec and/or provide aggressive stimuli. That did not go well for them. And that behavior is just stupid and almost always escalates situations.

"Hello [name] - I'm [so-and-so], I'm one of the ED nurses and I'm here to help you" [or, "I'll be helping take care of you today"]. Ask why they have the towel over their head (maybe severe photophobia, etc). If they do not answer, explain your moves. "I need to remove the towel so we can find out more about what's going on with you today." [remove it].

Low stimulus, low(er) lighting, low tone of voice, etc.

Etc.

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Nope, can't touch them.... don't they teach you that in BLS...no more tap the victim say "are you okay" they can sue you for assult. 😜....geesh the things you hear.....or read ..it's a crazy world!

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PeakRN specializes in Adult and pediatric emergency and critical care.

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Yeah... if you act unconscious your going to get assessed. Whether that means tapping, sternal rub, pinching nail beds, or a pop-up timer (when they pull the NPA they are sober to read test) you will be touched. If you don't like it find somewhere else to sleep.

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Pixie.RN is a MSN, RN, EMT-P and specializes in EMS, ED, Trauma, CNE, CEN, CPEN, TCRN.

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3 hours ago, PeakRN said:

Yeah... if you act unconscious your going to get assessed. Whether that means tapping, sternal rub, pinching nail beds, or a pop-up timer (when they pull the NPA they are sober to read test) you will be touched. If you don't like it find somewhere else to sleep.

Yep, this - if a patient seems unconscious, we would consider that emergent and act under implied consent. 

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Mandy2016 is a BSN and specializes in Emergency.

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Something I ask myself is if I or someone I loved presented this way, what would I want someone to do? Chances are, both you and a judge would reach the same answer. Any person who wouldn't want to be touched is either full of empty threats or is so sue-happy, you'd better believe they've lost all of their credibility and things will go in your favor anyway. 

But... if you're still worried about touching a patient, here are some alternatives:

-Crank the head of the gurney up 90 degrees

-Pull the blanket/towel away

-One or two drops of saline from a flush onto the head

-Drop something loud on the ground/ make some noise.

One physician I work with has a rubber chicken. Yes, the cheap prop store kind. It's his first level-of-consciousness check after saying hello and, oh boy, does it work.

 

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Go ahead and call the police.  Please tell them you were in the ER, not responding (voluntarily or involuntarily) and now you want to file assault charges because someone tried to wake you up.  See how that goes for you, buddy.  

You came to the ER.  I will assess you and that means I NEED to talk to you if you are conscious.  If you do not open your eyes or verbally respond, I will give you a good sternal rub.  I also like to unlock the bed and give it a good shake.  Very effective.  

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On 3/16/2019 at 11:54 PM, CSUSM10 said:

Is it ok to touch a pt to check responsiveness?  If a patient with a triage note stating ems found them unresponsive was lying supine in a bed with a towel over the head and not responding to being called, is it ok to touch them (tap their foot) to check responsiveness? Sounds weird, i know, but there was a patient threatening to call police for assault for doing just that.

The triage note would simply not state that EMS found the PT unresponsive-

As soon as ABCs were assessed, the triage nurse would assess level of responsiveness him/herself.  As far as touching?  Technically speaking, the standard of care is inflicting pain, as LOR is put roughly into 4 categories (AVPU):

Alert

Verbal

Pain responsive

Unresponsive

Most of us will take a few steps between V and P. Tapping a foot for example.

Touching a patient is a part of any assessment. Anybody unable to verbalize consent or refusal falls under implied consent.  Failure to adequately assess a patient is a breach of responsibility.

Nobody actually working in an ER is worried about a PT calling the cops after his foot got tapped.  Or ear lobe pinched, or a chest nuggie, or god knows what creativity the overworked night nurse came up with at 0400.  Nose hair grows back anyway.

BTW-  Hand drop.  hold the hand a foot above the face, let go.  Do not do this if they are wearing a heavy watch and are actually unresponsive.

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On 3/31/2019 at 10:04 PM, Mandy2016 said:

Something I ask myself is if I or someone I loved presented this way, what would I want someone to do? Chances are, both you and a judge would reach the same answer. Any person who wouldn't want to be touched is either full of empty threats or is so sue-happy, you'd better believe they've lost all of their credibility and things will go in your favor anyway. 

But... if you're still worried about touching a patient, here are some alternatives:

-Crank the head of the gurney up 90 degrees

-Pull the blanket/towel away

-One or two drops of saline from a flush onto the head

-Drop something loud on the ground/ make some noise.

One physician I work with has a rubber chicken. Yes, the cheap prop store kind. It's his first level-of-consciousness check after saying hello and, oh boy, does it work.

 

What about warm water in a bed pan, then just trickle a bit on the PT's head?

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nurse2033 is a MSN, RN and specializes in ER, ICU.

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Of course, you would be negligent if you didn't. You can give a brief trial of talking to them, then "Annie are  you OK?" shaking, then pulse check. It is your duty to identify and treat any life threatening condition. Unresponsive qualifies.

Edited by nurse2033

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"nursy" is a RN and specializes in ICU, ER, Home Health, Corrections, School Nurse.

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On ‎4‎/‎16‎/‎2019 at 5:57 PM, hherrn said:

 

 

  Nose hair grows back anyway.

Love it!  🤣

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In the ED? Like a patient who has been roomed and is waiting to be seen, and has since fallen asleep with a blanket or towel over their head?

I turn the lights on, address them, if they don't respond I address them more loudly. If ignoring me, I tell them I'm taking the towel off, do that, and sit the bed up to 90 deg. If they do not respond I open their eyes and check pupils. Usually the people who are malingering for shelter or just very tired/drunk respond by that point. If no response, I'm going to gently rub their sternum, check pulse/breathing and escalate as needed (e.g. eval airway, gag, etc).

Edited by TuxnadoDO

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