Give me a break. Ever done a sternal rub? Orbital pressure? Nail bed pressure? These are all accepted ways to check for reaction to pain and way more harmful/painful than letting someone's hand fall.
Dispatch said seizure lasting 20min, Really!?
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Give me a break. Ever done a sternal rub? Orbital pressure? Nail bed pressure? These are all accepted ways to check for reaction to pain and way more harmful/painful than letting someone's hand fall.
VFlutter
Flight Nurse
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Side effects of her medications should also be considered, particularly the Fludrocortisone. The moms comment about progressively getting more frequent and longer could be a sign of toxicity. Would explain the hypertension, convulsions, fatigue, and other s/s.
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medic417
The Truth Provider
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Give me a break. Actually give the patient a break that is a broken nose.
Wow we have some real brilliant people hanging around this place.:wacko:
Melclin
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Ahhhhh beat me too it.
The world of seizures is a big and complex world. I'd be cautious with statements like, there has to be a post-ictal period. There is a lot about obscure neurological conditions that I don't know. So I'd prefer not to use absolutes like that.
That said I think people who are faking it are pretty obvious. I've never had to use it for fakers in the seizure realm because I've never had one I couldn't talk out of it, but for fakers of unconsciousness I've used the hold their eye open, show them a 14g cannula and tell them that if they're really unconscious, they'll need one of these inserted trick. Interested in what you've said mycrofft. Our laws are obviously different but I'd be interested to know whether or not I could get into legit legal trouble using this trick.
VFlutter
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Have you ever seen a skin laceration caused by a sternal rub? I'd rather take the broken nose
I prefer a good trap squeeze or nipple twister. Kind of joking about the second one... But the trap squeeze does work great if you do it right
medic417
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:unsure::unsure::unsure:
I have not said in this topic that I endorse any form of torture being described in this topic. But given a bruise minor laceration of sternum skin or a broken nose I'll take the bruise/laceration thank you very much.
Where are you seeing these broken noses? How far do you think people are dropping these hands from? It's tough to break a nose throwing a punch, much less dropping a limp arm with no force placed behind it.
If you are dropping their arm from high enough (frankly I question whether its possible) to break a nose you are doing it wrong. The whole point is to drop it low enough that the only way they can avoid hitting themselves is with a conscious effort.
So your against those "torture" methods, then tell me how do check responsiveness? Or are you going to tell me that response to pain isn't an important thing to know?
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medic417
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Seriously? You think it takes that much force? I really see no benefit it discussing this point with those that obviously know so little.
VFlutter
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It takes about 30g of force to fracture the nasal bone.
Force = mass x acceleration. With the average mass of a persons hand and how little it should accelerate (dropping from a foot) I highly doubt you are going to see many fractured as a result of this.
Also regardless of your personal opinions it is a widely accepted and legitimate test that you will find in most Neuro books (under hand-face drop test) such as Emergency Neurology: Principles and Practice By Sid M. Shah, Kevin M. Kelly
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JPINFV
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I was hoping I wouldn't be the first to point out that there's a difference between pseudo/psychogenic seizures and a patient faking it.
It takes roughly 76 lb. (340N, or 35g) of force to break a nose on average. So I'll say again, if you can generate that much force by dropping someones hand/arm you are doing it wrong.
That data is from "Essential Tissue Healing of the Face and Neck" pp. 20, table 2-1. Force is listed in N, conversion from N to lb is .22481 for those interested.
Edit: Unrelated note, you can disagree with me all you like, but the little personal shots are unnecessary.
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VFlutter
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*cough* Ad Hominem *cough*
In regards to the "brilliant people around here" and "not knowing anything about the topic" comments......:rofl::rofl::rofl: seriously? I would like to think we all have provided good information and feedback in this thread. What have you brought to the table?
Serioulsy what is up with people lately. If you want to state an opinion then that is totally fine but have some decent logic and evidence to back it up as well as be able to disagree with people without assuming they are dumb for having an opposing opinion. What ever happened to good old civilized discussion :glare:
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medic417
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Bravo. Finally some science rather than this is how we always do it or this is how the doc said do it. Happy to see some people rather than getting mad and making stupid remarks try and back their choices with real proof.
Keep up the good work.
Keep up the good work.
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How about not dropping the hand on their nose? And from six inches it's not going to make a single bit of difference anyway. It's not torture, it is a legitimate test as provided by other posters. I also read of it an athletic training practice "bible" the name of which escapes me.
mycrofft
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Is the ammonia inhalant disregarded because it is prone to abuse (put in nose, squeeze nares to pop..) or misuse, or is it something else?
JPINV, I was away, thanks for pointing out a conversion disorder seizure form episode is not the same as a factitious psueodseizure.
Encepholographically, neither will exhibit the waves seen in a real seizure.
Pinching, poking in the eyes, twisting areolae, grubbing on the sternum....
I bet water boarding would work, too. These are not only going to possibly "leave a mark" when used, but will look GREAT on Youtube via someone's cellphone camera.
JPINV, I was away, thanks for pointing out a conversion disorder seizure form episode is not the same as a factitious psueodseizure.
Encepholographically, neither will exhibit the waves seen in a real seizure.
Pinching, poking in the eyes, twisting areolae, grubbing on the sternum....
I bet water boarding would work, too. These are not only going to possibly "leave a mark" when used, but will look GREAT on Youtube via someone's cellphone camera.
JPINFV
Gadfly
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Actually it was Chase that pointed it out in this thread.
mycrofft
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OK, thanks to her/him also.
Is the ammonia inhalant disregarded because it is prone to abuse (put in nose, squeeze nares to pop..) or misuse, or is it something else?
JPINV, I was away, thanks for pointing out a conversion disorder seizure form episode is not the same as a factitious psueodseizure.
Encepholographically, neither will exhibit the waves seen in a real seizure.
Pinching, poking in the eyes, twisting areolae, grubbing on the sternum....
I bet water boarding would work, too. These are not only going to possibly "leave a mark" when used, but will look GREAT on Youtube via someone's cellphone camera.
I just don't have ammonia. Never have in this region. Not sure why, have never asked.
mycrofft
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Ammonia inhalants are prone to abuse or ignorant use . Proper technique from my experience: before pt is clearly in sight, don gloves and put capsule in your hand. In one motion crush the capsule and just swing it under their nose, about an inch away, don't hold it there for more than a second. Keep it handy, don't toss it, you might want to do it once more.
Do not do the following: use more than one at a time, contact the pt with it, hold it under their nose for more than a second, use it without gloves, use it to punish a patient.
In fact, before you do it to a patient, do it to yourself.
Practical tip: store them in a rigid container, I carry two in a serum aliquot tube with their corners bent to allow them to be shaken out. Otherwise they tend to get crushed prematurely, and most will then have a reddish stain to indicate they are used up. ANd your kit will smell like ammonia.
Note the pt reaction, can include the following or more: opens mouth to breathe, eyes open, turns head away, suddenly awakes (I mean at once, no obtunded state), tries to strike you (note degree of accuracy), or occasionally comes up obtunded and sometimes aggressive like when wakening a passed out drunk on the street.
Do not do the following: use more than one at a time, contact the pt with it, hold it under their nose for more than a second, use it without gloves, use it to punish a patient.
In fact, before you do it to a patient, do it to yourself.
Practical tip: store them in a rigid container, I carry two in a serum aliquot tube with their corners bent to allow them to be shaken out. Otherwise they tend to get crushed prematurely, and most will then have a reddish stain to indicate they are used up. ANd your kit will smell like ammonia.
Note the pt reaction, can include the following or more: opens mouth to breathe, eyes open, turns head away, suddenly awakes (I mean at once, no obtunded state), tries to strike you (note degree of accuracy), or occasionally comes up obtunded and sometimes aggressive like when wakening a passed out drunk on the street.
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