amelia's plum

I have to give a presentation on Friday about noxious stimuli and maximizing stimulus response. If you don't know what I'm talking about don't worry, I didn't either until yesterday in class during my neuro assesment lecture. It's basically about eliciting a response in an unresponsive patient with the last resort, pain. And the instructor kept stressing how we should be creative with our presentations. And me and my sick mind I instantly went to Marathon Man with the dental torture scene and then to the whole S&M scene. Especially since one of the pain responses I remember seeing, and actually blurted out in class, was pinching the nipples. Which I think caused more than a few of the nine other students in my class to raise an eyebrow, my instructor somehow managed to keep a straight face. But when she mentioned it again I said that I remembered that from an episode of House and then, everyone was like 'oh, of course' and went off on how House makes all these medical gaffes, like I've mentioned before. But the thing is I'm trying to look up these various methods of arousing a response. And a lot of people say never do the nipple twist (apparently it's a twist, not a pinch, and that is what Foreman did to House when he was found not breathing) but then these online forums say that's the one things that elicits a response when all else fails. What are the other methods of noxious stimulus you ask? pressing down on the nailbed with the side of a pencil or pen (one commenter recommended a tongue depressor instead of a pen to avoid cross contamination), sternal rubs where you press (some say use your knuckles, others the palm of your hand) along a patient's sternum and firmly rub (this is supposed to be unbearably painful), pinching the trapezius muscle (not easy to do with a petite nurse and a larger patient), pinching an ear, pressing a finger firmly on the supraorbital bone (which can give a nasty headache but you can't do with a suspected face, skull fracture), and ... the Liverpool health service policy says 'genital pain may be used when other forms of recognised painful stimulus have failed to elicit a response from the patient. It is not to be used as a first line assessment of patient response to stimulus by staff.' How in the world am I to give this presentation with a straight face? I mean it would be 'creative' if I dressed up as a dominatrix but then we get graded on wearing appropriate attire for the presentation so I think that's out. The odd thing is why is the nipple twist so vilified when the other methods can also cause pain and bruising, the sternal rub is just as painful if not more so. It's like the parent that is vehemently against spanking but has no problem pinching their child or digging their nails in the child's arm hard enough to leave a mark. Now I'm not advocating spanking, pinching, nipple twists, any of this stuff! And God knows I'm not looking to have my nipples twisted if I was a patient in the ICU. Why couldn't I have gotten a cranial nerve for my presentation. WHY?