Aidey
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This is an issue that comes up every so often at work, and I'm wondering how you guys approach it.
Many people I work with seem content to assume that most patients who are conscious but won't respond to questions are just "playing possum" and there isn't anything legitimately wrong with them. I prefer to approach it as if they do have an issue and only consider the "possum diagnosis" as the last option. This has garnered me some ridicule at work, along with people calling me gullible and naive.*
Basically, my question is how do you convince people that you don't think a patient is playing possum?
*Here is the pt info for that situation. 40ish F assaulted by her boy friend. He hit her 5 times in the head, and she has 3 palpable bumps on her head, and the beginnings of a black eye. He chased her out of the house and down the street where she fell, a passerby called 911. It is unknown if there was an initial LOC. Her GCS when I arrived was 15. Pt states she has drank 4 beers this evening, denies any other alcohol or drugs.
Pt was backboarded by FD PTA for neck pain. We're transporting and shes crying and saying how much her head hurts and how scared she is when suddenly, mid word she stops talking and crying. I look over at her and she is flaccid, eyes open and staring straight up. I try and get her attention with both verbal and painful stimuli, to which she has no reaction. She also did not close or twitch her eye lids when her lashes were flicked and she failed the hand drop test. It lasted for about 45 seconds to a minute before she came out of it. When she did, she picked up mid word right where she stopped off, was crying again etc.
I don't remember her exact vitals, but they were within normal limits, and her CBG was in the normal range also. The only abnormal finding was that her L pupil was sluggish to respond compared to her R pupil. Her L eye was the one that had the beginnings of a black eye around it.
I am about 99% positive she was having an absence seizure (no seizure hx though). I had a friend growing up who had them, and so I've seen quite a few and it was to the letter the exact same thing.
My partner that day is a paramedic student waiting to test, and she, along with the nurse taking report at the hospital were both convinced I was "taken" by the pt and she was playing possum. I tried convincing them otherwise, and that is when I was called gullible and naive. The ED was swamped so I was never able to talk to the doc myself.
Basically, I don't think of myself as gullible or naive, I see it as being cautious. I don't think there is anything else I could have done to test this pts LOC, and yet I'm being treated as if I fell for some big trick.
Many people I work with seem content to assume that most patients who are conscious but won't respond to questions are just "playing possum" and there isn't anything legitimately wrong with them. I prefer to approach it as if they do have an issue and only consider the "possum diagnosis" as the last option. This has garnered me some ridicule at work, along with people calling me gullible and naive.*
Basically, my question is how do you convince people that you don't think a patient is playing possum?
*Here is the pt info for that situation. 40ish F assaulted by her boy friend. He hit her 5 times in the head, and she has 3 palpable bumps on her head, and the beginnings of a black eye. He chased her out of the house and down the street where she fell, a passerby called 911. It is unknown if there was an initial LOC. Her GCS when I arrived was 15. Pt states she has drank 4 beers this evening, denies any other alcohol or drugs.
Pt was backboarded by FD PTA for neck pain. We're transporting and shes crying and saying how much her head hurts and how scared she is when suddenly, mid word she stops talking and crying. I look over at her and she is flaccid, eyes open and staring straight up. I try and get her attention with both verbal and painful stimuli, to which she has no reaction. She also did not close or twitch her eye lids when her lashes were flicked and she failed the hand drop test. It lasted for about 45 seconds to a minute before she came out of it. When she did, she picked up mid word right where she stopped off, was crying again etc.
I don't remember her exact vitals, but they were within normal limits, and her CBG was in the normal range also. The only abnormal finding was that her L pupil was sluggish to respond compared to her R pupil. Her L eye was the one that had the beginnings of a black eye around it.
I am about 99% positive she was having an absence seizure (no seizure hx though). I had a friend growing up who had them, and so I've seen quite a few and it was to the letter the exact same thing.
My partner that day is a paramedic student waiting to test, and she, along with the nurse taking report at the hospital were both convinced I was "taken" by the pt and she was playing possum. I tried convincing them otherwise, and that is when I was called gullible and naive. The ED was swamped so I was never able to talk to the doc myself.
Basically, I don't think of myself as gullible or naive, I see it as being cautious. I don't think there is anything else I could have done to test this pts LOC, and yet I'm being treated as if I fell for some big trick.
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