Seizure pts 101

Specialties Emergency

Published

fyi for new er nurses: ive worked er for two yrs - my biggest pet peeve is when nurses/techs/whoever, let seizure pts ambulate to the bathroom, down the hall, to the phone, wherever. does it not make sense that pts coming to the er for seizure activity should not be allowed to get out of the bed until they have been treated? pts will argue that they are fine..dont let them persuade you. we had one man go to the bathroom after his second load dose of dilantin (he had just gotten it) - he shut the door and locked it. 30min later, the nurse notices he never came out. security had to come unlock the door. he obviously seized and fell hitting his head on the sink. he never recovered. i dont let seizures pts get out of bed until at least 30 min after their second load dose - even then, they shouldnt be sent off alone.

I have found that some of our older seizure pts are very familiar with signs and symptoms of seizure activity. We have one lady who always pees on herself and drools at the mouth.

I have used the hand drop method. Other ways of telling, are to use a yanker to suction the mouth. If the pt "purses" her lips or sucks on the yanker - chances are they are faking it. Another method...(may seem harsh,but it works)- get some saline in a syringe and squirt a small amount to the face. If they are faking, they will twinge. I hardly ever have to go that far - but some patients are very convincing. I had a pt once, tell me in advance that he felt a seizure coming on. I realize people have auras, but 20 to 30min pryor??? Please!! Also, on men - you can drop the arm/hand over their "private parts" -they NEVER hit it if they're faking it. Its really sad for the patients that arent faking it. And, we have a lot of patients that arent.

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"purple nurple"'s or sternal rubs usually will get an "OOOOOOOOUCH" from a patient when they are faking it.

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Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.

I worked in an Epilepsy Monitoring Unit for five years. I found it a very interesting place to work!

People who have pseudoseizures do indeed have psychological issues, which need to be addressed.

Without an EEG going, it can be very difficult to differentiate between a pseudoseizure and a real focal or partial seizure. I don't think pinching nipples or rubbing sternums are necessary maneuvers. The "hand drop" can indeed work, and you're not inflicting a lot of pain.

If someone has an honest-to-God generalized tonic-clonic seizure, you usally know it. Cyanosis and the like are very difficult to do on purpose! Also, if someone injures himself or herself during a seizure, it is very unlikely to be a pseudoseizure.

I have seen "foaming at the mouth-" this is the result of heavy salivation without swallowing and irregular breathing. I've seen quite a few folks bite their tongues; it's not pretty but not as ugly as aspirating something put into the mouth, or a bit of broken tooth. Viscuous lidocaine was a standing order for us. Urinating was relatively rare. I also saw one or two folks who vomited during a seizure.

Some people have both "real" seizures and pseudoseizures. I've also seen folks whose illness became their identity. They went through the long work-up, had surgery, had their seizures reduced or even eliminated, and then started having pseudoseizures. They couldn't seem to cope with the world without being a seizure patient. Very sad.

The numbers of people who have focal or partial seizures actually seemed to me to be a lot higher than people having generalized seizures, and they are much more difficult to diagnose. As an NP, I have diagnosed one lady who was in her 50's. She had fractured her arm and I was questioning her to figure out how it had happened. She described to me a "spell" that she had and said she'd been having them since early childhood; she'd had one and had fallen. Her husband described these spells to me and then her daughter did as well. I could picture exactly what they were describing and told them that I thought she was having seizures. I referred her to a neurologist and she confirmed the diagnosis. Her daughter told me that in all the years she'd had seizures, her mother had been told that she had "anxiety attacks." The patient did not remember anything about her episodes.

I became interested in working with epilepsy patients when my husband started having seizures as an adult. He scared the life out of me one night by having one- I thought he was stroking out or something! I took him to the ER and the doc there, who never bothered to talk with me, said that *he* was having an anxiety attack! (He woke up confused and scared and kept saying that he was scared). The next day he could hardly talk- had chewed his tongue a bit- and had so much muscle soreness I had to help him out of bed! I talked with some neuro nurses who told me that didn't sound like anxiety to them either, and who referred me to an epileptologist, who diagnosed him. The second seizure, a few months later, resulted in shoulder surgery.

The happy ending is that he only ever had one more. It was when our older son was 18 months old. That son is getting ready to go to college!

Sorry to ramble- this is a "soapbox" subject for me! Susan

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Ok this sounds just as cruel as the "drop test" but in order to rule out someone faking unresponsiveness I hold open an eyelid and with my other hand bring my index finger toward their open eye. If they are faking it they will squint as you get closer to the sclerae (usually once you touch the eyelash) :coollook:

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Kelnich did not say that! Learn to read the post better!

Pseudoseizure is not "faking". It has a psychological aspect to it - please do some further study on it.

Just because someone doesn't "foam at the mouth" or become incontinent doesn't mean they didn't have a seizure. Seizures manifest themselves in many ways. I've had two generalized seizures and didn't urinate on myself because I HAD JUST GONE TO THE BATHROOM. :)

Please don't assume folks are "faking".

steph

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Specializes in Emergency.

Great post!!

in the ER I work in, The padded SR's go up upon arrival. The patient doesn't ambulate anywhere until discharged, or an order to ambulate.

So far in my 1 year ER experience this is a known thing in my ER.

Thanks again for the great reminder to everyone!

xo Jen

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this is a problem on the floor too. a new admission in with seizures asking to go down and smoke. i can't tie them in bed but i can insist a family member be with them (after explaining the risks).

if pts insist on going out to smoke, one of the er docs makes them sign out ama (because they're are being non-compliant), we take out their iv's, which most of them hate, because they know they will have to get stuck again if they come back in. on the other hand, i got to where i would ask the docs for nicotine patches if the pt was going to be admitted. you really cant expect someone to just stop smoking because they are in the hospital...if anything, this makes it more stressful on them.

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Specializes in Telemetry & Obs.

My daughter has seizure disorder well controlled with Dilantin.

She has often told me when she feels a seizure coming on, has never urinated on herself, and never "foamed at the mouth".

And I'm pretty sure she's NOT faking it :)

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I just wanted to say that I myself had a seizure. I lost conciousness, urinated on myself, had tonic-clonic motions. I did not "foam at the mouth" and I did have an aura (luckily which told me something was wrong so I sat down) EEG cannot rule out Epilepsy, they can only confirm it. Auras can last 20-30 mins, an "aura" is a simple partial seizure in itself. Generally it manifests into a TC seizure but not always. You are lucky if you only get the simple partial. You would have to catch an actual seizure on the EEG and sometimes they occur so deep within the brain that they don't even show up on the EEG. I have done extensive research on Epilepsy and seizure disorders. I am going into nursing school in a week. Probably half the reason this facinated me and have done sooo much reading on the subject. I think that opening a seizing persons eye and pointing your index finger near it is extremely dangerous! Here is a link to show how many different types of seizures that there are. If they aren't TC it is hard to even realize they are happening unless you work for a neuro, have extensive training in seizures, or have them yourself...check it out:

http://www.epilepsyontario.org/client/EO/EOWeb.nsf/web/noct

Peudo seizures are really not Faking. That is really the wrong and outdated term. This kind of seizure truly does manifest from anxiety or mental issues. It is actually not electrical discharges from the brain causing this, but still a serious issue. I can tell you that after I was in the hospital for three days, I decided to get a second opinion. I couldn't believe I had such a horrible seizure and why I couldn't figure out. This loser neuro told me I had simple syncope and told me after he got my EEG results I could assume driving. He was so sure he was right. Well when the ordering neuro got my EEG results they were abnormal. I had sharp spiking in my frontal lobes, suggesting seizure activity nocturnally. Needless to say the second neuro never even called me back..he was so sure of himself and probably was shocked when he got those results. I have realized that seizures are very serious no matter what kind of epilepsy you have. I currently take Keppra BID 500/MG and have been seizure free...knock on wood. Sorry this is lengthy, but I wanted to give my point of view

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