Faking or not faking? That is the question.

[ERDoc]

It is the frequent fliers that scare me the most, especially the drunk ones. They always get put in a corner and forgotten about. I don't want to be the one on duty the day that they actually have something and it gets missed because everyone thinks they are just drunk again and end up in the corner.

Another technique that I find works (very similar to Rids) is to tell someone that if they don't wake up and start talking that I will have to assume the worst and put a tube down their throat to make sure they keep breathing and a tube in their penis. A colleage of mine likes to ask the nurse, in front of the "unconscious" patient, to get 5cc of that new drug Nakel (NaCl). He makes a point to say, "It's a good thing for him he really is unconsious, because if he wasn't this new drug could kill him." I have never tried it, but he claims a 100% success rate.

[tddubois]

Thanks guys,

I agree arm test = bad idea. Im glad for him that he failed. In retrospect I suppose the call went well. Off to go "save" some more!

[Beagle189]

Have your company by Ammonia Ampules. Pop one under the nose and if they are faking you will no it quickly.

Also depending on how much ETOH the pt ingested he could have "Passed out" from intoxication and resp. drive depressed enough to have caused his unconsciousness. Your treatment stimulated all his right receptors and Bam! He's awake.

[vs-eh?]

One clue to decide whether or not this patient was faking. He reported a 13/10 pain scale, but had those vitals...The pain response can come in 2 forms, sympathetic response (more common in my experience) or vagal mediated response (less common in my experience). His vitals are essentially normal. I always love asking patients to rate their pain. Ya, it's a 10/10...and they are just sitting there giving the occasional groan and vitally sound. This is the WORST PAIN YOU HAVE EVER HAD? YES. Hmmmm, ok...

Now there are things that may mask/alter pain response/perception but all things being equal given what you said I would question this patient. But working in a large city tends to jade you at times (which can be a bad thing).

Admitted ETOH use and alcoholic. Could explain the hypovetilation and altered LOC, sure it can happen that fast (not that I would know or have experience with that :roll: ). I wasn't there so I can't comment on what I would have done, but you did no harm so kudos.

[HEAD inj]

Don't sweat the small stuff....you did what you were trained to do.... That is react to what was going on at the time

as the old USMC saying goes kill them all and let God sort them out....JUST KIDDING...

You did a VERY good job with what you had....

Watch, listen, ask and learn.....

[EMS49393]

Treat every patient as though they are NOT faking and you'll never go wrong. In the event they are a frequent flyer that is truly sick and you aggressively treat them, you keep your butt safe. In the event they are faking like a big dog, worse case scenario you insert an airway and they puke all over you and viola, they're saved. It's not your job to guess if they're faking or not, that's up the to the docs, that's why they have the big MD after their name... for My Decision (and their lawsuit if wrong). I, personally, don't have any desire to waste my malpractice insurance on a frequent flyer that I didn't treat to the best of my ability just because I've hauled him to the ER seven times in two days.

Just my opinion, take it or leave it.

[Janmarie3]

Drunks are weird cases, they like the drama, they want the attention. Most drunks drink because they are drowning one sorrow after another, so they are going to play you and think, Sweet! finally someone cares about me. Once they get that...they know where to go for more. I give them some sympathy even though I know they fake it sometimes, but I don't care. Deep down I feel a little pity for them. What really bugs me is the ones who come over on a bus...gets kicked off the bus...and then conjures up some emergency and calls us for transport back to the town he came from. I have gotten to where I can usually pick them out and I call for PD to come deal with them.

[Ghettomedic351]

Kinda reminds me of the story...you know the one....the little boy that cried wolf, someday they just might need genuine care, so in my thoughts you should treat them all as genuine emergencies, because the one time you dont.....you will get burned.

[Ridryder 911]

Most of the time it comes with time and experience, even then sometimes you get fooled. Yes, tx. as if they are real (within reasons) sorry, it not just the Dr.'s job to find out... you are educated to assess and find out as much as possible,

No, I will not stick I.V.'s or attempt to intubate, place oxygen,perform a FSBS on every so-called drama person.

Be safe,

Rr 911

[Janmarie3]

That is good advise Ridryder,

The reason I called PD to handle the bus patient is because I did assess his complaints. But I found nothing wrong with him. When I first arrived on scene he was sitting outside very agitated and all he wanted to do was get in the ambulance and roll. I was reluctant to put him in the ambulance. I asked the questions and while he was answering me he told me how he ran from the cops and stepped in a mound of spiders and he was bitten a bunch of times on his feet and he couldn't even walk. I had him remove his shoes and socks and what I found were old blisters. No spider bites. He complained of feeling sick and faint. As my partner was taking his vitals the security personnel told me that he had been kicked off the bus, broke into one of the hotel rooms and was taking a shower when they caught him. The pt didn't want to be arrested so he began complaining of being sick.

Because I didn't find anything to warrent an ambulance ride to a hospital 45 minutes away, and being the only personnel on duty that day. I felt that PD should be called in to handle it so we wouldn't be tide up when a real emergency happened. When we returned and I returned to my home. I was outside watering the lawn when I looked up and saw that same guy walking past my house. He was walking just fine.