Pt faking seizure

[VFlutter]

You claim that many of us do not understand your condition and that we are being insensitive but do you understand our position? You say that you have worked with health care providers but have you ever done a ride along or encountered the type of deliberately faked seizures many of us are talking about?

Go shadow a day in an urban ER. I am willing to bet you will see at least one person faking a seizure and using your legitimate medical condition as an excuse to get what they want. It is truly unfortunate and frustrating because it does make us numb to those, like you, who actually suffer from those conditions. Everyone gets burned out when 99 times out of 100 a person is crying wolf. I am sorry you are the 1 out of that 100 who isn't but the true blame falls on those who purposely abuse the system.

Can you imagine how frustrating it is to have a person who is obviously faking a seizure taking up a ER bed when others are suffering in the waiting room. To have a person fall to the ground and flail around screaming and yelling for dilaudid? This is the norm for many of us.

 

[Dada Simba Detuned]

I get it, really I do...

But there are still things you can do to help minimize the psychological distress experienced by your patients that in the case of PNES can exacerbate their acute symptoms. A lot of my points apply to other health conditions as well, but as I am not diabetic or have Alzheimers, etc. I cannot comment from that perspective as a patient. I do not at all mean to insinuate that any first responder means me harm... but it doesn't change the fact that if you scare me I may not be able to control my physiological responses. I am not saying that I am not accountable for my actions... but that doesn't mean that I can always control them at the time of the acute PNES episode. l spend thousands of dollars and hours of my life trying to better manage my health condition... I have better things to do than waste your guys time. Unfortunately, I do not always have that choice... trust me if I could just "NOT HAVE THEM" I would have done so by now!

This is also something that most medical providers rightly or wrongly associate with recreational substance use, which is a legitimate and serious medical concern. If you're getting aggressive and not responding positively to my benzos, with no prior knowledge of your history, it's a pretty safe bet that you're getting sedated by force in your treatment pathway.

Most paramedics, myself included, think 'drugs?' when we come across a seemingly irrational patient. Horses are usually horses, not zebras.

I know that my point of view sounds horrible, but I am genuinely interested in learning more about your medical condition. Inferring that I'm going to rape you, that I am a completely ignorant barbarian/volunteer, and that I am only intent on forcing myself upon you and causing physical and mental harm is insulting to say the least, as is being judged for my appropriate treatment of patients with the exact same complaints, symptoms and medical history because it doesn't work for you is mildly insulting when you don't even recognize that your complaints and symptoms are not exclusive to your condition.

I'll listen to you if I ever run you as a patient and I'll do pretty much what you ask me to if you can provide me with a good reason. "I want drugs" is not a good reason, nor is "don't tie me up because it gives me TEH FLASHBACKS and I'M BEING RAAAPPEDD" and similar nonsense when you're demanding a ride but demonstrating aggression/uncontrollable movements that could endanger yourself or others. It's an inconvenience to bandage a cut on your hand from flailing into my equipment/cabinets, clean the cabinets and document why I allowed accountable, physical harm to come to my patient. It could subject me to financial penalties or even loss of employment. That's why you're restrained when you're 'seizing' and you don't want/don't respond to sedation (don't have RSI here yet). Don't want that? Educate your peers and maintain enough self-control to effectively communicate with EMS. If you can't do that- maybe you should be transported?

 

[RocketMedic]

You claim that many of us do not understand your condition and that we are being insensitive but do you understand our position? You say that you have worked with health care providers but have you ever done a ride along or encountered the type of deliberately faked seizures many of us are talking about?

Go shadow a day in an urban ER. I am willing to bet you will see at least one person faking a seizure and using your legitimate medical condition as an excuse to get what they want. It is truly unfortunate and frustrating because it does make us numb to those, like you, who actually suffer from those conditions. Everyone gets burned out when 99 times out of 100 a person is crying wolf. I am sorry you are the 1 out of that 100 who isn't but the true blame falls on those who purposely abuse the system.

Can you imagine how frustrating it is to have a person who is obviously faking a seizure taking up a ER bed when others are suffering in the waiting room. To have a person fall to the ground and flail around screaming and yelling for dilaudid? This is the norm for many of us.

My wife waited at UMC-El Paso for two hours with what turned out to be PID because of one of these patients. I literally called my PA (active duty at the time) and met him at the WBAMC urgent-care clinic to get her treated in something like a timely fashion.

 

[Dada Simba Detuned]

I have done all that you suggest as part of my past jobs...

I worked in an emergency room in the 80s and as part of my job as an emergency response planner I did the rest... I get it... but just because many of your patients are "faking and drug seeking" in your opinion doesn't mean that we all are. And PNES is believed to be much more common that previously understood.

I worked in the medic tent at Occupy Boston... trust me I know what it's like to have combative drug seeking folks come at you in a tent when you're working an overnight shift all alone. I HEAR what you are saying... but it doesn't change the fact that many of my and others' experiences are unnecessarily negative.

You claim that many of us do not understand your condition and that we are being insensitive but do you understand our position? You say that you have worked with health care providers but have you ever done a ride along or encountered the type of deliberately faked seizures many of us are talking about?

Go shadow a day in an urban ER. I am willing to bet you will see at least one person faking a seizure and using your legitimate medical condition as an excuse to get what they want. It is truly unfortunate and frustrating because it does make us numb to those, like you, who actually suffer from those conditions. Everyone gets burned out when 99 times out of 100 a person is crying wolf. I am sorry you are the 1 out of that 100 who isn't but the true blame falls on those who purposely abuse the system.

Can you imagine how frustrating it is to have a person who is obviously faking a seizure taking up a ER bed when others are suffering in the waiting room. To have a person fall to the ground and flail around screaming and yelling for dilaudid? This is the norm for many of us.

 

[RocketMedic]

But there are still things you can do to help minimize the psychological distress experienced by your patients that in the case of PNES can exacerbate their acute symptoms. A lot of my points apply to other health conditions as well, but as I am not diabetic or have Alzheimers, etc. I cannot comment from that perspective as a patient. I do not at all mean to insinuate that any first responder means me harm... but it doesn't change the fact that if you scare me I may not be able to control my physiological responses. I am not saying that I am not accountable for my actions... but that doesn't mean that I can always control them at the time of the acute PNES episode. l spend thousands of dollars and hours of my life trying to better manage my health condition... I have better things to do than waste your guys time. Unfortunately, I do not always have that choice... trust me if I could just "NOT HAVE THEM" I would have done so by now!

Simba, I understand that you don't like being restrained or sedated, but from our point of view, if we're restraining or sedating you, you're a threat to yourself or others. I'm not going to take the risks associated with transporting you unrestrained alone in the back of an ambulance on the 20% chance you might get aggressive with me when I can simply restrain you and spare us both a fight. I don't let people randomly flail in the truck. That's how paramedics get hurt and fired.

 

[Dada Simba Detuned]

I'm sorry about your wife... but...

MY point is that if my head is bleeding and I'm concussed and/or aspirating vomit I deserve attention before other patients who are not as acute... I am "one of these patients" and I have a right to appropriate and compassionate medical case as much as your wife, sorry but (I believe) that it is true!

My wife waited at UMC-El Paso for two hours with what turned out to be PID because of one of these patients. I literally called my PA (active duty at the time) and met him at the WBAMC urgent-care clinic to get her treated in something like a timely fashion.

 

[Dada Simba Detuned]

I'm not asking you to...

I'm asking you to listen to and respect me when I (try to through my stuttering) explain that I will remain much calmer if you let ME put the seatbelts on and let me get into the truck myself without you touching me unless I am actually falling down and about to hurt myself. It's common sense actually, but you'd be surprise at how hard it is to get folks to listen to you when you are stuttering and shaking... though most EMTs are much better (in my experience) than ED docs.

Simba, I understand that you don't like being restrained or sedated, but from our point of view, if we're restraining or sedating you, you're a threat to yourself or others. I'm not going to take the risks associated with transporting you unrestrained alone in the back of an ambulance on the 20% chance you might get aggressive with me when I can simply restrain you and spare us both a fight. I don't let people randomly flail in the truck. That's how paramedics get hurt and fired.

 

[the_negro_puppy]

MY point is that if my head is bleeding and I'm concussed and/or aspirating vomit I deserve attention before other patients who are not as acute... I am "one of these patients" and I have a right to appropriate and compassionate medical case as much as your wife, sorry but (I believe) that it is true!

Let me ask you this. Have you ever had a PNES alone at home or do you only ever have them when other people are around you?

 

[RocketMedic]

Oh, if you're actually hurt, absolutely.

If you're simply having an Emotional Event, Disagree.

 

[Dada Simba Detuned]

Both...

A lot of the literature suggests than this is a dispositive criteria... they are DEF'y worse if witnessed by someone who makes me more anxious, either because they are scared or I think they will call 911. But I do have them alone at home (which is when it really sucks).

Let me ask you this. Have you ever had a PNES alone at home or do you only ever have them when other people are around you?

 

[systemet]

I absolutely do not intend to suggest that most or even any PNES is as urgent as an acute epileptic patient. BUT... if I am thrashing and concussing and aspirating vomit then I'd like to think I'd come before a rule out cardiac case that may just have GERD or indigestion or someone's kid with an ear infection or strep throat.

I'm confused, how are you aspirating vomit if you're conscious? Do you mean you're having small amounts of vomit enter your hypopharynx and trigger your cough and gag reflexes? If you're truely aspirating then you probably need to be intubated and placed on a ventilator. Have you had aspiration pneumonitis after these episodes?

You do appreciate, of course, that the rule-out cardiac case is also a rule-out cardiac case because they might be having an acute MI and be sitting in the waiting room developing long term disability and a shortened life expectancy with each passing minute?

I'm sorry if I came off as rude, but I have personally had extremely negative experiences with ED docs in particular in this country (not all - many, including my attending on Friday, are quite appropriate and compassionate and provide the best care possible given the constraints of the current US healthcare system).

I'm not offended, but I'd suggest that it might be inappropriate for a layperson to try and tell an ER attending how to practice medicine.

So... in that case, I should be treated like any other potentially hypoglycemia-induced seizure patient.

And you should be. Anyone exhibiting seizure activity, or potential psychogenic motor activity, or any sort of altered mentation should have their glucose checked and corrected if low. Any crew that isn't doing this should be getting in trouble.

Benzos and haldol (which wasn't truly administered with my consent) make me MUCH worse... it generally only happens when I'm incapable of communicating in a manner in which the health care provider can understand me or believe I'm competent to refuse Rxs... generally in the midst of the most acute of trauma reactions or afterward when I present as possibly post-ictal or hypomanic.

Have you considered getting a medical alert bracelet that indicates "paradoxical reaction to benzodiazepines?". Or to haldol? This might help. Unfortunately, if you're not able to communicate, this might just buy you some ketamine instead.

Obviously getting benzos is undesirable, but I'm sure you can see why this happens. Paramedics respond while you're having an episode, have no idea what your prior history is, or that you have an idiosyncratic reaction to benzodiazepines. They can't judge whether you're competent, so they default to transporting you to the hospital. They don't want to injure you attempting to restrain you while you're flailing, or they suspect some sort of atypical seizure presentation, so they administer the benzodiazepines to prevent you from injuring yourself during restraint/transport.

Regarding what "works"... mostly DBT grounding techniques and eliminating exposure to triggers (these will vary among patients depending on the nature of their trauma history). For me, triggers include pain, flashing or strobe lights, alarms or sirens, "unconsented touching or restraint", unexpected painful and sudden body movement (like someone patting me on the shoulder from behind on the side of my neck and shoulder injury), anything that is perceived by me as a sexual advance, etc. I often have difficulty being restrained in an enclosed area like the back of a truck with a strange man... but if it is an EMT who I know from work or a female I do much better. Many of the local EMTs know me so it is less of a problem for me than others who have similar triggers.

What's DBT? Honest question, I just haven't encountered the term before. I think what's being asked here is more, why are you going to the ER, and what are they doing for you there, if the benzodiazepines and haldol don't work? And what would you prefer we did in the ambulance?

From reading between the lines, it sounds like you're not calling 911 yourself, but bystanders are calling for you when these events happen in public? The best thing would be transport in a calm environment, lights low, no sirens, and being placed in a quiet room with minimal environmental stimulation for a few hours until it runs its course? Is that correct, or is it a misrepresentation?

I am sorry for the long and rambling post, but I am doing my best to answer all of the questions.

Thanks for answering them. As a result of this conversation I'm going to be a little more educated next time I see someone with PNES.

 

[Wheel]

How many of these episodes have you had in the last month?
How many times have you been transported to the ER in that time?
How many concussions have you had from this?
How many times have you aspirated?

 

[Dada Simba Detuned]

See, this is where I disagree...

when my "emotional event" converts into systolic pressures north of 160 the hospital won't let me leave the ED until it goes down. No matter what I do or say. (Of course I also clinically present with other disturbing symptoms that don't look like a panic attack to them so it's hard for them to feel comfortable,) There is in my mind no "bright line" between mental and physical illness... it's a continuum. That being said, if someone's bleeding out and I just look like I'm having a grand mal but there's no electrical activity on my EEG... PULEESE go stop the other patients' bleeding!

Oh, if you're actually hurt, absolutely.

If you're simply having an Emotional Event, Disagree.

 

[Dada Simba Detuned]

As much as I would like to advocate on my own and others' behalf...

This is getting a bit detailed and personal for posting on a public forum where I don't know most of you.

What is the relevance of these extremely detailed questions? I'll try to answer to the extent relevant to this discussion(s).

How many of these episodes have you had in the last month?
How many times have you been transported to the ER in that time?
How many concussions have you had from this?
How many times have you aspirated?

 

[Wheel]

I'm just curious as to how frequently this presents, and how frequently patients hurt themselves in these situations.

 

[NomadicMedic]

I think we've gone as far as we can go with this thread The OP has offered some insight into PNES, And in return the paramedics here have offered insight into the rationale behind their treatment.

Rather than delve into the personal medical history of the OP… I think it's time to call this one done