# Strange Procedures



## AustinNative (Jan 14, 2011)

So the rumor goes that our local EMS service sometimes uses an unusual procedure on pts they think are faking it to sleep in a warm hospital for the night (we have a large homeless population).  The procedure is called "the eye thump".  Basically they thump you on the eyeball, because no one who is faking it can not react to it.  I thought this was somewhat funny.

Have any of you heard of things like this?


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## lightsandsirens5 (Jan 14, 2011)

Don't even get me started on pts who are "faking" it.

Anyhow, to me it seems unneeded and cruel. A muscle pinch or reflex test should suffice. 

I have also hear of holding peoples eyes open and playing with their eyelashes.


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## yyc_ranger_4x4 (Jan 15, 2011)

My instructor had a great faker while he was working with a service...they got called to a prison for a seizing pt. When they arrived, all he did was ask him to stop seizing so they could take a look at him...guess what. He stayed there that night.


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## exodus (Jan 16, 2011)

If a pt is non-responsive, we need a patent airway. Drop an NPA. If they take it, but are faking, that's good enough for me to let them spend the night in a hospital.


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## Soco_and_Lime (Jan 16, 2011)

I once had a frequent flyer start shaking her hands and tell me to my face "Oh my god I'm seizing!!!!" 

As Exodus said, the one I always go to when pts are pretending to be uncon/unresp is the NPA.


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## Shishkabob (Jan 16, 2011)

Actually, the "eye-thump" is more of a way to check for ability to intubate.  Typically, if their eyelids twitch, they might still have an intact gag reflex.


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## shfd739 (Jan 16, 2011)

Linuss said:


> Actually, the "eye-thump" is more of a way to check for ability to intubate.  Typically, if their eyelids twitch, they might still have an intact gag reflex.



This. But don't thump the eye, just their nose between the eyes. If they blink there is prob an intact gag. Also worked on arousing my drunk pt the other night.


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## DesertMedic66 (Jan 17, 2011)

i have heard of the eye thump when a patient is faking. also on of the guys i used to know would lift the patients hand up over their face and let it go. usually if their hand smacked into their face then they were really out. if their hand moved to the side then they would be faking. he used to do it all the time to a girl that would "pass out" every week or two at the high school.


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## usafmedic45 (Jan 17, 2011)

> also on of the guys i used to know would lift the patients hand up over their face and let it go. usually if their hand smacked into their face then they were really out. if their hand moved to the side then they would be faking. he used to do it all the time to a girl that would "pass out" every week or two at the high school.



One of my personal tests for this although it's not a 100% specificity nor 100% sensitivity. Another trick I have is to announce loudly that you're going to have to shove a catheter "up their ****" or have to shove a finger up their butt.  You'd be amazed how many guys will immediately "come to" when you say either of those.  

I've also had a patient "wake up" when I offered him $20 to do so because it was obvious he was faking.  He sat up and I promptly told him I wasn't giving him the money.  He called me a :censored::censored::censored::censored::censored::censored::censored: and signed a refusal.  All in all, a good night.


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## fast65 (Jan 17, 2011)

It seems to me that a good, firm sternal rub would do the trick, no reason to be thumping peoples eyes, unless of course to determine if they have an intact gag reflex as Linuss said.


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## reaper (Jan 17, 2011)

You do not need to thump the eye to check gag reflex. Just touch the eye lashes with your finger. If they twitch, they may still have gag intact. 

No reason to cause pain to a pt. Faking or not!


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## Shishkabob (Jan 17, 2011)

reaper said:


> No reason to cause pain to a pt*. Faking or not!



Unnecessary pain*


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## Veneficus (Jan 17, 2011)

usafmedic45 said:


> I've also had a patient "wake up" when I offered him $20 to do so because it was obvious he was faking.  He sat up and I promptly told him I wasn't giving him the money.  He called me a :censored::censored::censored::censored::censored::censored::censored: and signed a refusal.  All in all, a good night.



Absolutely inspired!

I am definately going to put that to use.


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## MasterIntubator (Jan 17, 2011)

Its called a palpebral or corneal reflex, and has been adapted from anesthesia to assist in what stage of anesthesia they may be in.  It is not always accurate, and some folks just don't have it ( or its dimished ) like in many contact wearers.  But it is a good tool in the tool bag as non-destructive testing.  ( never thump the eye, your career may abruptly end if you cause corneal damage or worse. )

Cardinal rule for the new EMS:  Do not give the impression of doing harm when family or bystanders are watching ( bad boy old school EMS will fail many times these days in the eco-friendly politically correct litigation happy world we now live in ).

You bruise the wrong person via sternal rub... and you may see them again a year later in court with pictures.


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## Medic One (Jan 20, 2011)

Several things you can do is hold arm over face no person would smack themselves in the face when you let their arm go.

You can also use the MADD cap with a little saline and squirt in the nose.


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## usafmedic45 (Jan 21, 2011)

> You can also use the MADD cap with a little saline and squirt in the nose.



....or do it with just a flush syringe full of saline.


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## TraprMike (Jan 21, 2011)

Medic One said:


> Several things you can do is hold arm over face no person would smack themselves in the face when you let their arm go.You can also use the MADD cap with a little saline and squirt in the nose.



and explain to the ER Doc why there is a small cut on the Pt's forehead when the Pt is unresponsive and transport.


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## AnthonyM83 (Jan 21, 2011)

Medic One said:


> Several things you can do is hold arm over face no person would smack themselves in the face when you let their arm go.


 I'm not a fan of this, as I've seen many people try it and insist the patient is still faking because their arm naturally fell to the side. Not every single arm drop hits the patient's face, depending on angle, bulkiness of clothing, and patient positioning.


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## MasterIntubator (Jan 21, 2011)

Heck... you can be really cruel and just squirt ice water in the ear by syringe. h34r:


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## usalsfyre (Jan 21, 2011)

Knew an ED doc who would test for unresponsiveness by poking the nasal septum with an 18ga straight needle :blink:. Needless to say, I don't recommend this method...

My favorite is a pen or penlight rolled across the nailbed. Definitely painful enough to stimulate a response, but the pain subsides nearly immediately and no lasting damage is done. Perfect to test for response to painful stimulus.


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## usafmedic45 (Jan 21, 2011)

....be cause you forgot to remove the patient's ring before doing it.



> Heck... you can be really cruel and just squirt ice water in the ear by syringe.



Well, that and for the actually sick patients, this could provide some interesting and useful information.


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## MediMike (Jan 22, 2011)

Just throwing it out there with the arm drop thing..I uh...Heard a story (cough) about a young inexperienced cocky EMT who did this test with a drunk he thought was faking it, and failed to remove the large watch on the pt.'s wrist, and then spent some fair amount of time explaining the beat up nose to the ED doc. :unsure:


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## 8jimi8 (Jan 22, 2011)

how did we get 3 pages into this with no one talking about how unprofessional all your little tricks are.

You can test corneal reflex with eyelashes or actually touching the sclera with the corner of a sterile gauze.

You can elicit pain response with a trap squeeze.

Cold caloric?!  Wouldn't that cause more trouble for the medic than everyone other than a braindead person?


Seriously guys.  

Linuss, please don't let me catch you thumping patients in the eye. 

Truly sad guys.


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