Faking or not faking? That is the question.

[tddubois]

I had a call the other day. 52 y/o male, at a bus stop c/c “liver pain”. Pt stated he has a hx. of Hepatitis B & C and admits to ETOH. Pain is “13/10” started apx. 12 hrs ago, after he had started drinking. It looked like business as usual, another drunk, another faithful transport.

Then, Once I got him in the back and situated he started complaining that he couldn’t breath too well, and consequently started breathing heavily. I put him on a NRB, take his vitals so that I could give a quick entry note to the hospital, and the next time I look up he’s unconscious, and barely breathing. His vitals were normal ( I don’t remember exactly but something like 130/90, HR 80 RR 24). I found the pt. to be unresponsive to verbal and painful stimuli. I set the stretcher down flat, ripped the mask of his face look listened and felt for apx 10 seconds while grabbing a pulse, still had one, but his breathing was little to none. I hollered to my partner, no ALS available. I inserted an OPA, and began bagging, after apx. 30 secs to a min, pt. began gagging on the OPA, which I removed, however respiration's were still inadequate, so I continued bagging to the hospital.

Once there however my partner came around back, and asked me if he was faking, I told him I didn’t think so, although @ this point he did seem to be having some purposeful movement, while still keeping up the unconscious pose. We tried the “arm test” and sure enough it fell conveniently away from his face, leading my partner to believe that he was faking. Inside the hospital, the RN staff was saying that he’s a frequent (I’ve never taken him before) and that he does this all the time. I gave my report including the fact that he tolerated an OLP for apx. a minute as well as artificial ventilations, and they said they weren’t sure what was really going on this time. After completing my paperwork I poked my head in to drop off the hospital copy, and he was conscious and asked if I was the man on the ambulance who helped him. When I told him I was he thanked me, making me feel that perhaps I had accomplished something. However I couldn't help wonder in the back of my mind that maybe I had been taken for a fool.

So what do you think, faking or no? Does anyone have experience w/ conscious patients tolerating airways and ventilation like that? I’m a rookie, so I just went with what I thought had to be done, but who knows, it could have all been a show.

[Lithium]

I'll be honest ... I can tolerate BOTH OPAs and NPAs no problem. Insert them myself that is (don't ask ... bar bet).

All I'll ask you is this, does it really matter if he was faking or not? I understand that we as EMS providers feel cheated and sometimes enraged when patients make up ficticious complaints or pretend to be unresponsive, but usually when it gets down to it, it's a cry for help. Perhaps he really detests himself for putting himself in this lifestyle he's gotten into and wants out but doesn't know how ... or maybe just wants a comfy bed to sleep in for the night and warm food in the AM.

Either way, if your assessment leads you to believe the patient requires such and such, then do it.

As a sidenote, I'm not a fan of the hand drop test. Many years ago when I was on placement as a student, my preceptor did it to a patient who we believed to be 'faking it'. Turns out he wasn't, and the hand smacked him squarely in the nose. Now, not only did we have an unconscious patient who was unable to protect their own airway to begin with, we had an unconscious patient with a broken nose that was bleeding quite profusely. It was a constant struggle with suctioning to try and keep his airway clear ... Bad medicine.

peace

[AnthonyM83]

I'll be honest ... I can tolerate BOTH OPAs and NPAs no problem. Insert them myself that is (don't ask ... bar bet).

Oh...I could go so many ways with this one....

[Ridryder 911]

It could be either. Who knows.?.. Might have had some periods of apnea, but; yet again some could win an academy award as well ...

R/r 911

[akflightmedic]

I agree with what has been said.

1. Your immediate assessment led you to believe he needed those interventions. He tolerated them and appeared to have benefitted from them. You did your job. Congratulations!

2. NEVER NEVER NEVER do that stupid ass arm test!!! Instructors that still teach that are idiots. You do not do it for the exact reason mentioned above. It is stupid and can create more problems than you think. A simple, light flicker of the eyelashes works for most people cause they are unexpecting it, or pinch the earlobe. There are so many other less harmful ways to test someone.

[TTLWHKR]

Yeah, it wouldn't look so good if you broke the patients nose...

[strippel]

Last week we had a dramatic person of ethnicity. I was very suspicious (as was my partner), but family thinks she might be diabetic, they don't know. So we go with the NRB and as I move the patient (she was in bed sleeping, no trauma) to get the mask on, and her arm for the IV, I notice her head is not dead weight. She is supporting it, and trying poorly to move it with me. I tried the arm drop (yes, I am a bad boy), and she failed. But she took an 18 in her L ACF like a champ.

So, after the BGL comes back better than mine, another family member arrives with more drama. Amazingly, she wants to talk to her mom, so SHAZAM!, she is awake. I bet she would have tolerated a NPA, and tried like crazy with an OPA, but we didn't get that far. Had people take them before.

We all don't like getting duped. But as stated earlier, you assessed the patient, and provided the care deemed appropriate. And they made it to the hospital.

[ERDoc]

A little nailbed or knuckle pressure is a very noxious stimulus with little chance of causing any real harm and family members may not notice it if they are crowding around.

[medik8]

Hmmm....yeah...I agree with everyone here. Hard to tell whether he was faking or not, at this point. From what you said, it sounds like he may have been having some problems. In either case...you did the correct thing and the outcome was good. Good job!! It's easy for us all to forget the "boy who cried wolf" story, but even hospitals need to learn that just because someone is a "frequent flyer" it doesn't mean that they can't eventually have a real problem, sickness, emergency, etc... Treat every call as if it is an emergency. You can ALWAYS back down from interventions, but it's kinda hard to "wish" you had done them later when it's too late. Besides, like someone already said, the bottom line is, faking or not, he needs help in either case.

Funny story before I go....We had a big time faker one day. Now, I'm not a fan of this stupid arm test either. (I have to admit, I tried it a couple times in my career...just cuz... :dontknow: Thankfully, most all were fakers so I had no other injuries to worry with.) Anyway...back to my story...I knew this guy was faking like nobody's business, and I wasn't going to do anything like that to him. So, I proceeded to think of a clever way I could catch him off guard. About that time, my partner (driving) decides to take matters into his own hands. He bellows from the front of the truck in his most believable voice, "OH MY GAAAAAADDDDDDD.....A WHOLE truckload of naked women...LOOK at this!!!!!! HOLY CRAP.....Are you LOOKING at this? WHOOO HOOOOOOOOOOOOOOOOOOOOOOOO!!!!!!" Before I fully knew what was going on, I noticed my patient's eyes were like this... :shock: and suddenly...I had his FULL attention. This was one of those "had to be there" moments, but I've never seen anyone recover so quickly in my entire life. Even the usually professional me could not stop laughing in the back of that truck... Good times.... :D/

xoxoxo

Luv,

8

[Ridryder 911]

The "eyelid fluttering" or even the old arm drop will sometimes get them, not always. I agree with ER Doc, a little noxious stimulant is sometimes advisable. After I have determined that they are "faking it".. I will whisper in their ear, to cut this sh*t out, that they are not only embarrassing me, but themselves as well. That I really rather not put a tube in every orifice, and you can wake up slowly.. to prevent from looking like a dumb-arse. >90% of the time, this works.. it always amazes the fire crew as well as family on the speedy recovery! ...

Be safe,

R/r 911