forms of noxious stumuli

Specialties Neuro


looking for various methods of gaining attention from patients. From most common to most drastic.

I usually use pressure on the nail bed... but have seen the trapezius squeeze and sternal rub used. I'm curious as to what your gathering information for?

I have been in nursing for 15 years, For most of my practicing years I used the sternal rub, I just finished RN school and passed boards in July...we were taught that the sternal rub and trapezius thing left bruises, which often caused concern with patients and families therefore, now, pressure on the nail bed is the suggested form. Last week one of the aids came running to me and said so&so was not responsive...they had just talked to her...about one second after I applied fairlly firm pressure to the index finger nail bed, she opened her eyes and said"Hey, what'd ya do that to my finger for !" It worked...

We use a variety of noxious stimuli methods ranging from nailbed pressure on feet or hands, sternal rub, trapezius pinch, supraorbital pressure depending on other injuries and quality of patient response. We usually reserve train of four mechanicoelectrical stimulation for patients that require pentobarbital comas to reduce sustained high ICP.

We do not apply the nipple twist method of noxious stimuli.

Historically a sternal rub, trapezius pinch or supra-orbital pressure have been used to provide noxious stimuli. I have found that pinching the web between the thumb and index fingers provides plenty of stimulus to arouse the most sluggish patient. This method does not cause lasting impact, leaves no bruising and is less traumatic. Hope this helps. We need not hurt our patients to elicit a response. Thanks.

JCFowler said: "We do not apply the nipple twist method of noxious stimuli."

HAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHA thank you.. haven't laughed that hard in a long time

nipple twisting??? hee hee

I prefer the nailbed pressure technique..I have seen too many bruises with the trap squeeze and some who don't respond to the sternal rub but will sure enough withdrawl from nailbed pressure!!!

Have to agree with lalaxton. fingerpinch is a peripheral stimuli- it can and will elicit a reflex response. To do a through exam, you need to see if they respond to both peripheral and central stimuli. (This comes out of the Hickey text, as well as being required for our neurosurgery care plans.) Have seen trapezius and inner thigh pinched, sternal rub and a nipple pinch in desperation- oddly, the nipple pinch usually did get a response when nothing else would.

Dont Laugh! Have seen many a resident use nipple twisting that caused major bruising . I have also seen a neurosurgeon hit a patient with the flat of his hand on the abdomen (did not cause a bruise but left definite hand print) to elicit a response from a patient (then scream at me for calling him unnecessarily when the patient did respond). Just about anything will cause bruising if you pinch hard enough.

I am also wary of using finger pinch on deeply comatose patients as it can elicit a reflex response and not truly a withdrawal.

I usually use nailbed pressure and/or sternal rub. The other nice benefit of the nailbed pressure is that to an unsupecting family it actually looks like you're being theraputic :p

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