Is Your Patient Actually Unconscious?

Sometimes it can be difficult to determine if a patient is actually unconscious or not.  Here are 4 quick tips to give you an edge.

  1. Try assertive commands first– you might be surprised how quickly some patients will respond when you simply state “Open your Eyes” in a loud, firm manner.

  2. Try non-painful stimuli before painful stimuli– if your patient actually is sleeping and the first thing you do is bust out the EMS kung-fu, you will probably give the best first impression.  Try a gentle shake or the shoulder first, if the situation allows.

  3. Don’t go straight for the sternum rub– while the sternum rub is a classic technique, a committed faker can resist it.  Even more importantly, if your patient is experiencing a compromise of their peripheral nervous system, they may not even feel it!  A good firm trapezius squeeze is very effective, and will stimulate the eleventh cranial nerve.  Supraorbital pressure can also be highly effective.  Finally, while it is not as effective as the previous two, nail bed pressure can work wonders.

  4. Check their eyelids- I know, this sounds strange, but is in fact a good way to spot a coma impostor.  When you lift your patients eye lids in order to examine their pupils, pay attention when you let go.  If the eyelid slowly closes over the eye, this is likely true coma, if the eyelid snaps shut, your patient is probably giving you the run around.

In closing, be kind to your patients.  Remember that your goal when assessing for response to painful stimuli is just that, an assessment–not a free ticket to hurt people.  If your patient is faking, try to get to the root cause of why they feel the need to do it in the first place.  They may really need your help.

 

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