advice

[Just Plain Ruff]

I have found that if you can show the family members that the person is faking a seizure that it ramps up the dynamics 100 fold.

Had a seizure patient one day, family freaking out. Patient tracked me all the way into the room and watched me dig around my med kit.

I kept telling the patient "ok, I'm gonna start an IV on you, Is that ok?" and the patient would answer yes or no.

I then said "I don't think your airway is secure so I need to intubate you, but I first need to paralyze you so I can put the tube in" and amazingly the patient came out of the seizure.

I said to the patient "Aren't you ashamed of yourself faking a seizure and scaring your family half to death. Not to mention the calling of an ambulance and a fire truck to your house"

The patient replied "I'm sorry" and he signed the refusal.

As we were leaving all you could hear was the parents letting this dirtbag son of theirs have it for scaring them. Never got another call to his house.

The best ones are the ones who fake so well that they tolerate a IO needle due to their veins being so mucked up that the only place is the IO needle hole from yesterdays EMS call. Now that's Dedication

[DFIB]

Fake seizures are just about the only thing that drives me absolutely crazy. I can kind of get it when a mom or a grandmother does it to get some semblance of control and respect from their butthead families, I can even give some chick that has been dumped on by her butthead boyfriend, but I have no sympathy or tolerance for an adult male that is pitching a childish fit. We transport but I hate every second.

In my backwards location the ER Docs often inject the fakers with distilled water or alcohol just so they remember their trip under false pretentions is not something they want to do again.

Maybe we are not that backwards after all.

[brainurz]

unfortunately, they seem to be a regular occurence with the pediatric population, usually to get attention from the parents. the one that pissed me off the most, was I was working on a peds neuro floor and one patient was admitted for "seizures" one fine morning i went in to assess and she was "seizing" and resisting my attempts to open her eyes to assess pupils. i said, "you can stop now" she sat up, giggled, and said "ha ha just kidding!" i had to leave the room before i did something that landed me in jail (like smack the living sh:/) out of her. turns out, her sister had some chronic heart condition requiring repeated hospitalizations and this patient was feeling neglected.

[brainurz]

great read, btw. really needed the laugh

[xstreetsweeperx]

That article was entertaining if I do say so myself. My favorite part of it was when he said "hell, I went to school with a few people who were a couple of french fries short of a happy meal."

[MongoMedic]

I love this!

... now if someone would come up with advice for the pseudo seizure patient, it would make my day

I actually tried this with one of my patients...I asked them to hold still while I start this IV so I can give you some valium. Once they stopped I initiated the IV and transported. No valium but it was a funny story I had to share.

[tcripp]

Most recent patient of mine...got called out for chest pain and left sided weakness. Get there and the guy has moved to his upstairs bedroom so that he can have the seizures he feels coming on...and to protect himself because he usually falls and hurts himself. (Thank you sir for your consideration.)

Oddest thing I have ever seen, but this guys was having what I would call "ticks" and saying that his is seizure activity. He also says that he's got that feeling that a grand-mal is coming and had taken two of his dilantin to stave it off; FYI, he's not compliant with his meds, so he has no level built up at this time.

When we go to start an IV, he asks us not to. I explain that if things progress as he thinks they will, we need access so he agrees.

Is there seizure activity/convulsions that would ever present in this manner - small ticks while he is fully lucid? Part of me wanted to call BS but he's obviously been diagnosed with something else he wouldn't have the script in the first place.

[DFIB]

1. I understand that seizure activity can be very mild, Sometimes just a twitch or other uncontroled movement but it has been a long time since I thought about it. I will have to research it when I have a little more time.
   

[tcripp]

Dfib - it's the lucidity combined with the tick I am questioning...

[brainurz]

I've worked with neurology pts for almost 10 years now, so I know that seizures can come in all shapes, sizes, and flavors. Some people may just kinda "blank out" for a minute or two and go about their day as if nothing happened ( and likely don't bother calling ems as a result). However, individuals in this state will be unresponsive, even if only briefly. Some individuals with more severe symptoms may have an aura (most folks I've met, or read about describe flashing lights, strange odors or tastes, usually not twitching.) Plus some with an aura usually get enough warning that they can lay down in bed or on a clear spot in the floor because they know from experience that they're about to get kicked with a grand mal. I do remember reading about a particular seizure type called the "jacksonian march" that does start with extremity twitching and progresses to generalized seizure. So, tcripp, your patient may have had that. I don't know how common it is, so I'll do some digging on the topic after I've plowed through this cardiology lesson I'm working on