What is the recommended care approach for a patient who moves their finger in response to a verbal command?

Assessment of a Patient Moving Their Finger in Response to Verbal Command

A patient who moves their finger in response to verbal command is demonstrating moderate sedation (purposeful response to verbal/tactile stimulation), which indicates adequate airway control and requires continued monitoring at 5-minute intervals with documentation of level of consciousness, vital signs, and ventilatory status. 1

Level of Consciousness Classification

The ability to respond purposefully to verbal commands (such as moving a finger, giving a "thumbs up," or following simple instructions) confirms the patient is at a moderate sedation level rather than deep sedation. 1

• This purposeful response suggests the patient can control their airway and take deep breaths if necessary, which is a critical safety indicator 1
• Patients whose only response is reflex withdrawal from painful stimuli (not purposeful movement to commands) are deeply sedated and approaching general anesthesia, requiring escalated care 1
• The distinction between purposeful response and reflex withdrawal is clinically crucial for determining appropriate monitoring intensity 1

Monitoring Protocol for Purposeful Response

Periodically assess the patient's response to verbal commands at 5-minute intervals during moderate sedation, except when movement could be detrimental to the procedure. 1

Required Monitoring Parameters:

• Level of consciousness: Check ability to give "thumbs up" or other indication of consciousness in response to verbal or light tactile stimulation 1
• Ventilatory function: Continually monitor by observation of qualitative clinical signs and capnography (unless precluded by patient/procedure factors) 1
• Oxygenation: Continuously monitor with pulse oximetry and appropriate alarms 1
• Hemodynamics: Monitor blood pressure and heart rate at 5-minute intervals once sedation is established 1

Documentation Requirements:

Record the patient's level of consciousness, ventilatory and oxygenation status, and hemodynamic variables at minimum: 1

• Before administration of sedative/analgesic agents 1
• After administration of sedative/analgesic agents 1
• At regular intervals during the procedure 1
• During initial recovery 1
• Just before discharge 1

Staffing and Safety Requirements

Ensure a designated individual other than the practitioner performing the procedure is present to monitor the patient throughout, trained in recognition of apnea and airway obstruction. 1

• This designated monitor should not be a member of the procedural team but may assist with minor, interruptible tasks once the patient's sedation level and vital signs have stabilized 1
• Set device alarms to alert the care team to critical changes in patient status 1

Neurological Context Considerations

If the finger movement is being assessed as part of neurological examination (rather than sedation monitoring), test the ability to follow commands by asking patients to open/close eyes and grip/release hand to evaluate motor response. 2

• Assess both sides for comparison to avoid incomplete motor testing 2
• Document any asymmetry in motor response, which may indicate neurological deficit 2
• Note any medications (sedation, analgesia) that may affect the neurological assessment 2

Common Pitfalls to Avoid

• Do not confuse reflex withdrawal with purposeful response: Only purposeful movement to verbal/tactile commands indicates moderate sedation; reflex withdrawal indicates deep sedation requiring different management 1
• Do not reduce monitoring frequency: Even with appropriate responses, continue 5-minute interval assessments throughout the procedure 1
• Do not proceed without capnography: Unless specifically precluded by the patient or procedure, capnography should be used continuously as it reduces hypoxemic events 1
• Do not allow the proceduralist to be the sole monitor: A separate designated individual must be responsible for patient monitoring 1