the best, the worst......what's your experience with pt's faking illneses etc?......seems lately at my ER, seizures seem to be the malady of choice.....l have decided to earn my retirement writing a book on how to fake a realistic seizure......the do's and don'ts....the other evening we had a chick having a "seizure".....full body, but she could talk and make eye contact....hmmm, AND....when l triaged her and asked her if she was having any pain, she said "yes, my chest where the nurse pinched me yesterday"....uh, yeah....she was in the day before with the same c/o. One time, we even cured a sz with a miricale drug called sodium nacl....(pronounced: so-de-um na-kel)..........
tips:
1 do not make eye contact
2 do hit your self in the face with your arm when it is dropped on your face.
3. do not tear up when the amonia cap is broken
4 do piss yourself
5. puking is always effective
ok, that's all l can come up with for now, and l am bored of war talk.....please help me earn my retirement;)
gizzy, l wish l had a nickel for everytime l have told a pt....."You need to take your fingers out of your throat"...l have caught many trying to induce the old heave- ho.......we had a "migraine in the other day....walking around the room, laughing and talking loudly w/ visitors, lights on....she didn't even have the decency to fake it...... but she did get some Toradol....LOL!
Hey guys, I have actually been on both sides of the fence here. I have been diagnosed with temporal lobe seizures since about 1997. However I have been having seizures since 1994 when I was in the Navy stationed in Puerto Rico. They were so bad they thought I had a brain tumor and medievaced me to Bethesda Naval Hospital Maryland for eval. I don't remember the trip because I was pretty much out of it most ot the trip. When I got there every single damn test came back negative and I spent three lovely fun-filled days on the psych ward diagnosed with .... you guessed it.... pseudoseizures! Anyway, fast forward to two years later, two witnessed petit mal seizures later, I am driving home from work, I pull up to my apartment, open my car door and proceed to have the hugest grand mal seizure ever witnessed by the paramedics the were called to my rescue! Funny how this time both my EEG and my MRI both came abnormal this time and how I then have to take Tegretol for a long time and now I currently take Topamax. Pseudoseizures? I don't think so. Anyway, I know that there are fakers out there and I have seen my share but I am definitely not one of them.:)
you stated (and quoted):"But when there are comments from a nurse like brefni's "I don't understand what the attraction is..." it bothers me. There is no attraction, there is no though process "gee, I think I'll fake seizures to get into the hospital and get some attention, drugs, or to perform". As I said before, it's a pysch illness same as depression, or phychosis, amnesia etc. "
I genuinely believe that some actually premeditate about how they'll pull their act off, for whichever "chronic" (exacerbation of) illness (seizures, pain, etc)...Is there a psych component there? OF COURSE...but I've got to be concerned about true life-threatening conditions in my patients, or actual pain, etc...
Maybe this is a stretch, but , should career criminals receive lesser sentences, because of abuse/neglect in their past. ..
Look, patients w/ psych histories, that consciously make symptoms up for attention, take care away from those that really need it, and it frustrates us all here...If someone calls 911 for what is later to be found a "pseudoseizure", and does it monthly, then, in my world, let's hand him an ambulance transport bill ALONG WITH his therapy...
sean
Again, I wasn't talking about those patients. But I read what you had to say. Thanks for sharing, you opinion is appreciated. (I never did say fakers didn't exist.)
When I worked in ICU on nights years ago, we had a run of attempted OD's. We had decided to write a book "Suicide... the right way to do it". People who take 15 tylenol and then complain with the mucomist treatment get me all the time. I just shake my head and want to say "DUH", esp when they are repeat offenders with the same kind of OD. You think they'd figure it out.
Okay, I work agency. I was at one hospital one night. this guy comes in claiming a history of dvt s to his upper arms. They put him on heparin gtt. So the @@S hole is yelling in pain. So, with 6 other pts, I spent half my night on pain control for him with part of this time being on the phone with the doc. To get this guy stronger pain meds. So, my night ends going home feeling sorry for this guy.
Two nights later i am in another hosp and the same guy is there with t he same complaint. But now they have him on a pca.
So I call the doc and he orders a search of all the hospitals he had visited that week and also a search of rxs he had gotten. I was mad! I asked the doc if I coul write an order for a vastectomy for this guy but he wouldnt do it. Instead he is looking at some serious felony charges. One being insurance fraud.
Ive probally had at least 20 people with "abd pain" this past year.
They want thier pain meds iv. They are "allergic" to anything po, unless it is oxycontin of course. Sorry, but I dont feel sorry for the fakers. Psych case or not.
But I do treat them like any other pt I have with "real" pain. Im not there to judge someones pain for them, I cant. I can just try to help control it. And if they need a psych eval Ill have the doc order it. These "fakers" do need help, but not on a non phsyc unit.
funny how the abd pain fakers always ask for something to eat....l don't think so. 3d shift guy...l still find your statement about ppl not planning a trip to the hosp fascinating.....l am not badgering about it, but it calls to mind a distant relative....many yrs ago, she was so hooked on soap operas that l believe she lost the ability to separate fantasy and real life.....this was back in the 60-70's....she had every malady and tragedy that her soap stars did......and when they got pregnant, she would too and talk about how her and so-and-so were expecting....if it weren't so pathetic it would be hilarious.....of course this was back in the day when there were only about a half a dozen soaps on the tube, otherwise....l think the population increase would have been off the charts...LOL.....
funny how the abd pain fakers always ask for something to eat....l don't think so. 3d shift guy...l still find your statement about ppl not planning a trip to the hosp fascinating.....l am not badgering about it, but it calls to mind a distant relative....many yrs ago, she was so hooked on soap operas that l believe she lost the ability to separate fantasy and real life.....this was back in the 60-70's....she had every malady and tragedy that her soap stars did......and when they got pregnant, she would too and talk about how her and so-and-so were expecting....if it weren't so pathetic it would be hilarious.....of course this was back in the day when there were only about a half a dozen soaps on the tube, otherwise....l think the population increase would have been off the charts...LOL.....
Didn't mean to imply there aren't many people who go to the ER faking. I know there are lots of drug seekers that go to the ER specifically for drugs. They go with all sorts of ailments, abdominal pain, back pain, migraines, and seizures.
I just didn't realize that people think, gee I need a fix, so I'll go to the ER and have a seizure. Now I know better.
HOWEVER, there is a condition called psuedoseizures where the person doesn't consciously decide to have a seizure. Now their seizures are not by the book, they talk during them, the are not incontinent, etc. But they genuinely believe they are having seizures and not because they want to get high.
I'm trying to distinguish these patients from drug seekers.
It's a condition, kind of like depression, or alcholism, or pschizophrenia. It obviously isn't common. But since we have the video monitor studies, perhaps I've seen the more often than not.
Just don't think that everone who is having a fake seizure is looking for drugs.
Working the special needs unit , I see MANY behaviors....but many we find are px related. Rx the px and the behaviors disappear. Granted in ED this doesn't apply.....but in LTC....It works for us...
l.rae
772 Posts
gizzy, l wish l had a nickel for everytime l have told a pt....."You need to take your fingers out of your throat"...l have caught many trying to induce the old heave- ho.......we had a "migraine in the other day....walking around the room, laughing and talking loudly w/ visitors, lights on....she didn't even have the decency to fake it...... but she did get some Toradol....LOL!