Pt faking seizure

[Anonymous]

How do you document this? Do you put that the patient was faking the seizure or since there is no definitive way for us to know do you treat it as a real seizure. Or do you put it appeared the patient was faking?

 

[Mystwaker]

Treat as is and document all your findings. Unless your ALS is managing this pt there isn't a whole lot the basic can do. Manage their ABC and treat any secondary injury or illness from the "seizure". I wouldn't document that you thought it was fake, maybe something along the lines of this pt presented with seizure like activity.

 

[leoemt]

It is an official medical condition called Psuedo Seizures, often related to psychotic problems.

In my report which is the SOAP format:

A - Possible Psudoseizures

There is your documentation.

http://en.wikipedia.org/wiki/Psychogenic_non-epileptic_seizures

 

[Aidey]

Actually, faking seizures isn't a medical problem. Psychogenic seizures are. Big difference. And they are related to psychiatric problems, not psychotic.

It is only proper to say possible pseudoseizures if the pt has already been diagnosed with them. Otherwise the proper way to document it is to write something like "seizure like activity". If you want to get more specific you can further describe the situation like "Non rhythmic seizure like activity without neurological impairment"

 

[usalsfyre]

Easy...."patient showed organized neurological activity during the episode including x"(moving away from painful stimulus; clenching eyes shut; rapid, controlled muscular jerking; whatever)

Psuedoseizures is a actual ICD9 diagnosis that requires ruling out a host of other factors. I'd be careful using that one.

 

[Anonymous]

Perfect thanks guys

 

[Veneficus]

"Patient is drunk"

We would never write that as part of any report.

"Patient is faking"

Why would anyone ever write something that said that in any form?

If it isn't written, it didn't happen.

If you want to communicate your suspicions verbally with recieving staff that is one thing. Writing it down or typing it out is entirely something else.

Now I am not suggesting people don't fake seizures. I have seen it fairly often. I can tell they are faking just like you can.

But having said that...

What does documenting that add to patient care?

What could go wrong if you did?

There are a host of rare conditions that can present with "seizure-like activity." Do you really want to be the 1 in 350,000 or so that documented a "fake" seizure when it turns out to be something you never heard of before?

Just my opinion, but I think "faking" is too subjective a finding. If absolutely forced to write something on it, I would stick to something like:

"No sources of neurological deficit or abnormal activity are readily identified."

 

[Anonymous]

"Patient is drunk"

We would never write that as part of any report.

"Patient is faking"

Why would anyone ever write something that said that in any form?

If it isn't written, it didn't happen.

If you want to communicate your suspicions verbally with recieving staff that is one thing. Writing it down or typing it out is entirely something else.

Now I am not suggesting people don't fake seizures. I have seen it fairly often. I can tell they are faking just like you can.

But having said that...

What does documenting that add to patient care?

What could go wrong if you did?

There are a host of rare conditions that can present with "seizure-like activity." Do you really want to be the 1 in 350,000 or so that documented a "fake" seizure when it turns out to be something you never heard of before?

Just my opinion, but I think "faking" is too subjective a finding. If absolutely forced to write something on it, I would stick to something like:

"No sources of neurological deficit or abnormal activity are readily identified."

Agreed, thus the reasoning for my questioning. Just wasn't able to figure out how to articulate it appropriately.

 

[Anonymous]

Also don't want to be the one to not document an initial finding and have it be one of the 1 in 350,000. Even if I don't document something it would be kind of hard to deny it happened with a room full of people.

 

[Veneficus]

Also don't want to be the one to not document an initial finding and have it be one of the 1 in 350,000. Even if I don't document something it would be kind of hard to deny it happened with a room full of people.

I am not suggesting not documenting what you saw, I am suggesting documenting your opinion on the significance of those observations may not be the best idea.

 

[MSDeltaFlt]

Actually, faking seizures isn't a medical problem. Psychogenic seizures are. Big difference. And they are related to psychiatric problems, not psychotic.

It is only proper to say possible pseudoseizures if the pt has already been diagnosed with them. Otherwise the proper way to document it is to write something like "seizure like activity". If you want to get more specific you can further describe the situation like "Non rhythmic seizure like activity without neurological impairment"

I've seen fake seizures. And I believe I have seen an undiagnosed psychogenic seizure. Totally lucid the whole time and was upset that nobody could/would tell her what was going on. Would have the "seizure-like" activity including post ictal-like state that looked real. I would ask her, "You sti with me?" And she would immediately nod her head yes. Weird.

 

[Anonymous]

I am not suggesting not documenting what you saw, I am suggesting documenting your opinion on the significance of those observations may not be the best idea.

Got it.

 

[Shishkabob]

How do you document this? Do you put that the patient was faking the seizure or since there is no definitive way for us to know do you treat it as a real seizure. Or do you put it appeared the patient was faking?

I never say someone is faking something on my official documentation (but will with my verbal to other providers)...


But I sure as hell will state things that will make the casual medical reader go "They're probably faking it", just the same as I won't say someone is drunk, but I will write things such as "Patient has a smell consistent with ETOH but denies diabetic history. Pt in possession of several open alcoholic containers. Pt slurred speech and had unsteady gait, aggressive" etc etc.

 

[Veneficus]

I never say someone is faking something on my official documentation (but will with my verbal to other providers)...


But I sure as hell will state things that will make the casual medical reader go "They're probably faking it", just the same as I won't say someone is drunk, but I will write things such as "Patient has a smell consistent with ETOH but denies diabetic history. Pt in possession of several open alcoholic containers. Pt slurred speech and had unsteady gait, aggressive" etc etc.

This.

 

[mycrofft]

There are so many "tricks" to "detect" a "fake seizure" which can boomerang or, at least, appear uncaring.

I'm still a devotee of the judiciously applied ammonia salts , but before you do it (in accordance with your protocols), try it yourself. Get a little respect for it. Idiots abusing any patient (even factitious ones) by putting them into the nares and pinching or just HOLDING them under the nose have given a valuable tool a black mark. I prefer it to pinching the earlobe or sternal rub (which some folks can resist very well,thanks).

But even NH3 is one more datum. The hard thing is when you are sure it's not a true seizure; besides safety measures, you ought to follow protocols because that's what you're paid for and it won't hurt the pt.

Often they would either admit it to me, or start grinning when I caught them out.

PS: saw a case of torticolis in a psych pt related to meds, and this person was conscious, scared, and unable to stop the writhing. The dispatch was "man with seizure".

"No Ammonia For You!"

 

[Aidey]

I never say someone is faking something on my official documentation (but will with my verbal to other providers)...


But I sure as hell will state things that will make the casual medical reader go "They're probably faking it", just the same as I won't say someone is drunk, but I will write things such as "Patient has a smell consistent with ETOH but denies diabetic history. Pt in possession of several open alcoholic containers. Pt slurred speech and had unsteady gait, aggressive" etc etc.

Excerpt from a report I wrote:

"EMS was contacted by Acme PD to remove the taser darts from a male. After the darts were removed Acme PD was advised that the pt did not need further medical attention at this time. Acme PD then advised the patient that he was under arrest. Immediately upon hearing this the patient fell slowly to the ground. The pts back began arching and his arms started flailing around. He also yelled "I'm having a seizure"


For the record we didn't transport him, lol.

 

[the_negro_puppy]

As you get more experience its easy to tell when someone's faking.

Check their eyes and breathing in particular.

Document it professionally:

45 y.o M pt nil hx of epilepsy or seizures / convulsions. On arrival pt was thrashing arms and legs on ground, breathing normally. Nil post-ictal phase or incontinence with patient fully alert shortly after. Pt states he suffers from 'pseudo-seizures'/

 

[Bullets]

I'm still a devotee of the judiciously applied ammonia salts , but before you do it (in accordance with your protocols), try it yourself. Get a little respect for it. Idiots abusing any patient (even factitious ones) by putting them into the nares and pinching or just HOLDING them under the nose have given a valuable tool a black mark. I prefer it to pinching the earlobe or sternal rub (which some folks can resist very well,thanks).

Not only do we not use ammonia inhalants any more, but we also dont do the sternal rub.

Pressure applied to Supraorbital nerve works all the time

But I sure as hell will state things that will make the casual medical reader go "They're probably faking it", just the same as I won't say someone is drunk, but I will write things such as "Patient has a smell consistent with ETOH but denies diabetic history. Pt in possession of several open alcoholic containers. Pt slurred speech and had unsteady gait, aggressive" etc etc.

I used to use this but have moved away from using this in your narrative. We had a DUI case go to court and was found in the drivers favor because the cop put this in his report. The argument was that Ethanol has a slight odor and the real smell comes from the rest of the drink, either beer or such.

We now say "patient has an odor of alcoholic beverage on breath"

 

[Medic Tim]

Not only do we not use ammonia inhalants any more, but we also dont do the sternal rub.

Pressure applied to Supraorbital nerve works all the time



I used to use this but have moved away from using this in your narrative. We had a DUI case go to court and was found in the drivers favor because the cop put this in his report. The argument was that Ethanol has a slight odor and the real smell comes from the rest of the drink, either beer or such.

We now say "patient has an odor of alcoholic beverage on breath"

seriously, this sounds like one of those "stories" told to students to scare them.

 

[abckidsmom]

PS: saw a case of torticolis in a psych pt related to meds, and this person was conscious, scared, and unable to stop the writhing. The dispatch was "man with seizure".

Acute dystonia? Dispatchers have to pick something, and if it involves abnormal movement, they usually pick seizures.