Seizures real vs fake - page 2

by princess pickles

42,284 Views | 38 Comments

Ok so there was a patient/IM that had a seizure (perhaps, unsure) and the staff that went were stating that it was fake because she was alert and oriented. I was wondering, how do you handle the fakers/manipulators/attention... Read More


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    One trick a coworker shared is rubbing a handful of ice on the person's belly. If they're faking they recover instantly, and most of the time they start to "come out of it" when you loudly ask the nearest officer for a handful of ice. I've never actually tried it, but there were no fake seizures on that nurse's shift!
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    the first thing I check is pupillary response.....pupils will generally be dilated and/or sluggish to respond to light. There is almost always nystagmus with the dilated pupils. As soon as they stop jerking, I generally start asking questions as if they are awake when I suspect faux seizures.....like do you take seizure meds, what med, when was the last dose, how long have you had seizures, when was your last drug level, was it low, etc. The fakers generally end up answering all the questions accurately, albeit with some drama. After 32 years of ER nursing I can say I've never seen anyone wake up from a seizure and be able to answer those type of questions.
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    We have SO many fake seizures it's ridiculous! There are 2 inmates who always manage to have "seizures" within 10 minutes of one another, even though they are in different units. We still have not figured that one out.

    I laughed at y'all's comments about the smelling salts because I have started to use those and they truly are "miracle workers" lol. Personally, I wish we could inform the inmates that "new research" indicates that large-volume enemas are the cure for seizures. But then again, some of them may like that.

    What's crazy is that we have a couple of inmates who are so predictable that the COs will call us in medical saying, "I/M ____ is going to have a seizure in 5 minutes...just a heads-up." Sure, enough, it happens. And they are such BAD actors! They come out of the "seizure" and they'll be like, "Wh- wh- where am I?" Nauseating, but funny as heck!

    This is how we outed this one malingerer: the Dr. came to the unit when the emergency was called, and he observed as we stated things like, "I don't know...if it was a real seizure, his jaw would be jutting out more," and the I/M jutted his jaw out. Then we said, "Yeah, his right leg would be at more of an angle" and other ridiculous, fake "symptoms." Every symptom we mentioned, the I/M would start doing. The Dr. finally ordered that next time he has a "seizure," he is to be put into the turtle suit (the green suicide getup) and put into the observation room for 4 hours. That room is FREEZING so it took only 1 time in there for him to be "cured."
    DawnJ, TriciaJ, mge9450, and 6 others like this.
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    WHOOP- I LOVE these- Being an ED nurse, we sure see a lot of them- We use the amonia ampule as well- Another good trick I learned from a Neurologist- If someone is having a "Seizure" or a "Coma"- taking a needle cover and putting it up inside their nose and wiggeling it will always casue them to react. Easy to tell the fakers from the real thing- much more accurate than the "Hand drop on the face"- Too many frequent fliers know that is coming-
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    A trick that was passed on to me was "Protecting their airway" with a nasal airway (NPA). That generally seems to weed out the fakers!
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    One of my favored methods for sorting out the real from the fake was an ammonia inhalant.
    This is our method of choice. It really separates the fakers.
    katkonk likes this.
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    We respond in a fashion that is evidenced based to include lab theraputic values, then if this behavior continues well it becomes a safety issue for our patients and they must wear a helmut while awake so they do not hurt themselves. Females will almost always have noseizures after the topic of helmuts come up. Men it takes one or two episodes before they get it.
    Again we respond always like it is real, you never know.
    IrishErin and kimmyjonc like this.
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    I have become a real fan of the ammonia inhalants. However, I am a bit intrigued by using an NPA to "protect the airway". Could that be considered battery?!? Inquiring minds wanna know!!
    katkonk and Orca like this.
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    I loved using ammonia inhalants! Then when I started working at a chemical treatment facility for adolescents there was one client who they claimed to have "seizures". They kept sending her out to the ER, repeatedly! I was tired of this & pulled on my corrections knowledge, grabbed some ammonia inhalants, cracked them & put them to her nose. It cracked me up to see her try to hold her breath then turn red, sit up & "come out of it".
    katkonk, Orca, and Findingmynitch like this.
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    Quote from Two Sheds
    I laughed at y'all's comments about the smelling salts because I have started to use those and they truly are "miracle workers" lol.
    They have helped us to separate a lot of the pretenders.

    What's crazy is that we have a couple of inmates who are so predictable that the COs will call us in medical saying, "I/M ____ is going to have a seizure in 5 minutes...just a heads-up." Sure, enough, it happens. And they are such BAD actors! They come out of the "seizure" and they'll be like, "Wh- wh- where am I?" Nauseating, but funny as heck!
    I was doing pill call on the yard one night. For some reason, we started about 45 minutes later than usual. While out on rounds, I got a call from an officer on a unit we hadn't visited yet, saying that an inmate in his unit was asking where his medications were. This particular inmate was notorious for fake seizures. I told the officer that we were running about 45 minutes late, but that we would be there. Not five minutes later, there was a man down call from this unit. We suspended pill call and went to the unit to find this inmate flopping on the floor of his cell like a beached halibut. I looked at him. "Knock it off." He stopped, sat up and looked at me. "Aren't you going to give me my meds?", he asked. "No, and I will be writing a notice of charges for abuse of the man down system. And by the way, you have delayed pill call for yourself and everyone else on this yard by another 45 minutes."

    This is how we outed this one malingerer: the Dr. came to the unit when the emergency was called, and he observed as we stated things like, "I don't know...if it was a real seizure, his jaw would be jutting out more," and the I/M jutted his jaw out. Then we said, "Yeah, his right leg would be at more of an angle" and other ridiculous, fake "symptoms." Every symptom we mentioned, the I/M would start doing. The Dr. finally ordered that next time he has a "seizure," he is to be put into the turtle suit (the green suicide getup) and put into the observation room for 4 hours. That room is FREEZING so it took only 1 time in there for him to be "cured."
    This is brilliant. I love the creativity that went into this.

    One thing I used to do, especially on night shift, is give malingerers what I call "concrete therapy". The two large holding cells at the front of our clinic have concrete benches - hard, uncomfortable and very cold in the winter. If a malingerer came to the clinic (seizures and chest pains, two of the most popular symptoms to fake, were the usual reasons they were there), I would leave him in the holding cell for 3-4 hours after the clinic visit for observation. When the inmate asked when he was going back to his cell, I would tell him that I had to observe him long enough to make sure that he was OK to return to the yard. Punishment? Yes, but easily medically justifiable. That cured a lot of our late night visitors.
    Last edit by Orca on Sep 17, '13
    TriciaJ, katkonk, and Findingmynitch like this.


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