Fake Seizures

[ambodriver]

arm drop test can rule these out.....

Then get everyone out of the room and tell 'em to get up and walk to the ambo!

[fakingpatience]

Check SpO2 during seizure. If it doesnt drop, chances are high it's not a seizure, but rather a hyperventilation tetany or a fake.

Doesn't help much after the supposed seizure, though.

How reliable is this? I had a patient I am 99% sure was in status epileptics, elderly lady seizing 10+ mins, seizure would occasionally break, for max 10 sec, where pt would have some response to pain, then would begin seizing again, eyes deviated, no gag reflex, no change in seizure activity with valium. But her pulse ox remain high 90s the whole time (although we did have her on supplemental 02 from the beginning).

[Arctickat]

No Gag reflex during the seizure? How did you check this?

[fakingpatience]

No Gag reflex during the seizure? How did you check this?

Respiratory rate became somewhat irregular, and it looked like she may be aspirating, so I put in an OPA, suctioned, and assisted ventilations. This was after witnessing her seizing for ~10 mins and 5 of valium IM (slight delay on scene for an ambulance, as we were in a fly car). The seizures did not have the "violent" flailing...

I was also told that if you touch an unconscious pt's eye and they have no response/ eye does not attempt to close to that stimuli, it is a good sign they have no gag reflex. Was true for this patient at least, can't speak to it as a rule though.

[DwayneEMTP]

Doesn't sound like a tonic/clonic seizure. My guess would be that this was syncope from another cause, or possibly a stroke. I've never seen, nor heard that I'm aware of, of a patient actually seizing that is breathing adequately.

Almost certainly something else was going on here that was mistaken for a seizure....

Edit. Question, and I'm not sniping at you...If she was unresponsive, breathing adequately, and not showing significant 'flailing', what was the reason for the Valium?

[runswithneedles]

I gave you a negative for that. Why would you take the albeit slight risk of injecting a substance into a patient with no therapeutic benefit for the patient?

I think he was joking on that. Ive heard other medics make similiar jokes with NaChl.

arm drop test can rule these out.....

Then get everyone out of the room and tell 'em to get up and walk to the ambo!

Ive heard the arm drop test isnt all that effective. Especially if the patient is experienced with the test.

Are you referring to arm drop on the face or the crotch? Ive heard about both of these tests. (Having never seen either one done I dont know if its just a joke or if its an actual test)

[ambodriver]

I think he was joking on that. Ive heard other medics make similiar jokes with NaChl.

Ive heard the arm drop test isnt all that effective. Especially if the patient is experienced with the test.

Are you referring to arm drop on the face or the crotch? Ive heard about both of these tests. (Having never seen either one done I dont know if its just a joke or if its an actual test)

Never tried crotch drop, i usually go on the face. Are they getting on to our trade secrets?

[Happiness]

We have a 40 something man here that has major seizures. His are from a brain injury he sustaned while dirt biking. (riding full gear and hit a tree. A branch went through his face mask, pushed his eye aside and right into the brain)

This particular event started with him swatting at a fly. It took us about 15 min to get there. When we got there he was in full grand mal and cyanotic. I somehow through the grace of god and some luck got an oral airway in and he went from 68% to 96 within minutes. Through out the call I did notice 2 things, the seizure seemed to be like a roller coaster in his symptoms, he never became postical but they did subside and then got worst. And his SP02 did flucuate through out the time with me it did go downward as the seizure got worse. In the end of this the guy seized everytime they brought him out of his drug induced coma for 7 days. The Drs were about to give up but the wife just asked for one more day to be with him. I saw him last week. It just goes to show that sometimes one more day is all you need

We have alot of ETOH seizures here. One of them woke up just as the pretty little red headed nurse came into the room and said "Hi beautiful I'm feeling much better now that your here" I just had to smile and walk away................