# Possible Seizure



## cannonball88 (Sep 10, 2016)

You're dispatched to assist law enforcement at the side of a state highway. You arrive in a one-man rapid response vehicle (ALS) to find a woman with her hands cuffed behind her back laying on her left side at the side of the road. She appears to be convulsing. Three police officers are standing in a semi-circle around her. One speaks up, saying "I was taking her to jail for assault, she blew a 0.15. She was in the back of my car and she suddenly started this."

What do you do and/or ask next? Your ambulance with two EMT-Basics is about 10 minutes out. You have a full arsenal of ALS supplies in your E-Car.


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## NomadicMedic (Sep 10, 2016)

Blood sugar. Fix if low. Vitals. Fix what's wrong. Benzodiazepines. Stop that shaking. 
Airway if you need to. 
Wait for ambulance. 
Put in ambulance. 
Drive to hospital. 
Wait for next one.


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## cannonball88 (Sep 10, 2016)

Airway's open, she's breathing around 26/min. BLG 94 mg/dL. BP 146/96. 5 of Versed IM given. Still shaking. She starts grunting and chokes out "Undiagnosed brain tumor."

Next steps?


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## NomadicMedic (Sep 10, 2016)

Sounds like incarcaritis to me. But, she can have more versed. 

And we drive to the hospital.


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## DesertMedic66 (Sep 10, 2016)

DEmedic said:


> Sounds like incarcaritis to me. But, she can have more versed.
> 
> And we drive to the hospital.


This. Check pupils (part of normal assessment) and then a nice transport to the hospital.


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## Handsome Robb (Sep 10, 2016)

How do you know you have a brain tumor if it's undiagnosed? 


Sent from my iPhone using Tapatalk


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## DesertMedic66 (Sep 10, 2016)

Handsome Robb said:


> How do you know you have a brain tumor if it's undiagnosed?
> 
> 
> Sent from my iPhone using Tapatalk


WebMD


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## NomadicMedic (Sep 10, 2016)

Handsome Robb said:


> How do you know you have a brain tumor if it's undiagnosed?
> 
> 
> Sent from my iPhone using Tapatalk


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## VentMonkey (Sep 10, 2016)

cannonball88 said:


> You have a full arsenal of ALS supplies in your E-Car.


Ah, but do I have ammonia ampules?


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## cannonball88 (Sep 10, 2016)

DEmedic said:


> Sounds like incarcaritis to me. But, she can have more versed.
> And we drive to the hospital.


The term I used was "stainless steel allergy."


Handsome Robb said:


> How do you know you have a brain tumor if it's undiagnosed?
> Sent from my iPhone using Tapatalk


That was my question too.

The end result? 10mg Versed total. Turns out she has a history of going into "seizures" when under arrest, but one of the more convincing I've witnessed.


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## zzyzx (Sep 10, 2016)

"...One of the more convincing ones I've witnessed."

The fact that she was talking and telling you she has a brain tumor while "convulsing" would be an indication that she is not having a true seizure.

That said, I have also been fooled a few times, even after years of experience and seeing many fakers. I remember one guy who was super tachy while "seizing," and I didn't even question that one until I brought him to the ER and the doc told me that he was malingering.


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## SpecialK (Sep 11, 2016)

How long has she supposedly been fitting?

What has our response time been since responded by Control?

Is she having a tonic clonic seizure? What sort of movements is she making?

I'd wait 2-3 minutes to see if she stops; most seizures spontaneously terminate after a few minutes.

If not, I'd give her 15 mg of IM midazolam (provided she is not very small or very old and if she were I'd reduce the dose to say 7.5 mg) and see what happens.


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## StCEMT (Sep 11, 2016)

cannonball88 said:


> Airway's open, she's breathing around 26/min. BLG 94 mg/dL. BP 146/96. 5 of Versed IM given. Still shaking. She starts grunting and chokes out "Undiagnosed brain tumor."
> 
> Next steps?


"She's all yours gents"
Go to QT. 
Get taquitos and Gatorade.
Celebrate another life saved.


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## thelapow (Sep 14, 2016)

PNES. Psychogenic Non-Epileptic Seizure.


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## NomadicMedic (Sep 14, 2016)

StCEMT said:


> "She's all yours gents"
> Go to QT.
> Get taquitos and Gatorade.
> Celebrate another life saved.



Eh, I'd still have to take her, after 5 of versed, but then I'd get Taquitos and Gatorade.


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## zzyzx (Sep 14, 2016)

thelapow said:


> PNES. Psychogenic Non-Epileptic Seizure.



Probably not psychogenic. There's a difference between someone who actually believes they are seizing and someone who is purposefully faking.


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## StCEMT (Sep 14, 2016)

DEmedic said:


> Eh, I'd still have to take her, after 5 of versed, but then I'd get Taquitos and Gatorade.


The first part was more wishful thinking, the second is just a way to make the trip out worth it.


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