Assess not assault.

The picture below is of a 26 yo female. Second presentation over a week following poly-pharmacy and alcohol overdoses. Can you identify the cause if this traumatic injury? As part of our neurological assessment ( checking level of consciousness or calculating GCS for example) it may be necessary to elicit some form of noxious stimuli on our patients. These stimuli may be divided into two categories. Central and peripheral. It is important to remember that peripheral stimulation may illicit a reflex response, completely bypassing the brain and therefore not giving an accurate evaluation of cerebral function. So we should assess for a central response first. Central Noxious Stimuli (in order of preference). Trapezius pinch: Stimulated by gripping or pinching the trapezius muscle (above the clavicle and close to the neck). Alternate sides during subsequent assessments to minimise soft tissue damage. If no response on one side you may try the other. May be difficult to perform in patients with really muscular, or short bull-necks. Mandibular pressure: Press your first and second finger upwards and inwards just under the angle of the jaw (think: jaw thrust). Should not be used if suspected fractures of jaw. Cannot use if hard collar in situ. Supra-orbital pressure: The supra-orbital nerve is stimulated by applying pressure to the indentation on the orbital rim near the nose. It should not be used if there is any facial, orbital or ocular trauma. Take care if you have long fingern...
Source: impactEDnurse - Category: Nurses Authors: Tags: clinical skills Source Type: blogs