R/O Seizures

Published

Specializes in Critical Care.

I had a patient last night who started doing this floppy/twitchy thing. Myself and a few other veterans were at the bedside with a new grad, who screamed "He's seizing". We explained that, no, he wasn't, and she asked how we knew.

I dunno, we just knew. After you see a few hundred, you just know, you know?

I did explain that he wasn't seizing since he would bite on his ETT until he ran out of air, and then miraculously stop and resat, but this didn't seem to convince her.

Any tried and true tests you know of to prove he was not seizing?:anbd:

Up Vote Up Vote ×

Um, an EEG? ;)

Up Vote Up Vote ×
Specializes in Critical Care.

Yeah, not really relative at 3 in the morning in an ICU. Not sure what your experience is, but without the 24 hour video approach, it can be hard to catch seizures. That's why they do it the way they do.

I rely more on my own clinical judgement and expertise than most technology. Betwee myself and the nurses around me there was more than 40 years of collective experience. I trust that, it is just hard to share with a newbie (all she had to help her was suggest ordering an EEG).

When I went back the next night the family admited that he has a psych history and has faked seizures for years.:icon_roll

Any clinical suggestionns?

Up Vote Up Vote ×
Specializes in PICU/NICU.

Our "seizure fakers" are a little smaller and not as "mature" as yours most likely are. I usually try the holding down of one limb or part of a limb- if I am able to, or the original type of movement of the limb changes or weakens... not a seizure. And I totally agree- sometimes you just know.

Up Vote Up Vote ×
Specializes in Critical Care.

Agreed-PICU/NICU patiets are usually not as adept at trying to play us!I wish!:wink2::loveya:

Up Vote Up Vote ×

i would wonder if the patient in the OP didnt start with pseudo sz, and finding the attention a good think progressed to "faking".......

Up Vote Up Vote ×
Specializes in Critical Care.

Could be, who knows.

OK seriously-do we as RNs not have any tried and true tricks for ruling out seizures?????? I thought for sure we would have some tricks up our collective sleeves.:coollook:

Up Vote Up Vote ×
Specializes in PICU/NICU.

How about the 'hand over the face'?? Usually I try this with our "unresponsive kiddos, but it has worked with some "seizure" pts. But like I said... ours are a little less mature.

Up Vote Up Vote ×
Specializes in ER.

a pseudo seizure responds to pain (I do a sternal rub)

they stop when you are out of the room, and increase with family present

they track your motions with their eyes while seizing

sometimes they stop if you tell them to.

Up Vote Up Vote ×
Specializes in ICU,CCU, MICU, SICU, CVICU, CTSICU,ER.

It's hard to say. Had a neurosurgeon show me and about 25 other experienced ICU nurses a video of "seisures" and we had to give our opinion as to whether they were real or not. We were shocked at what some of the actual seisures looked like, and of what some of the hard core fakers could do. One lady (a faker) could make herself foam at the mouth and would bite her tongue to bleeding! Another pt (real seisure) simply turned his head slowly to one side with a normal gaze then return his head to midline. It was fascinating, and the neurosurgeon made a good point--never assume....get the EEG.

Wish I could post a link to this video--it was when Keppra came out and was sponsored by the manufacturers. Anyone else ever see it?

Up Vote Up Vote ×
a pseudo seizure responds to pain (I do a sternal rub)

they stop when you are out of the room, and increase with family present

they track your motions with their eyes while seizing

sometimes they stop if you tell them to.

pseudo seizure is not the same as fake seizure......it is psychogenic, but not faked

Up Vote Up Vote ×
Specializes in ICU.

Painful stimuli is a good indication...

Also if the patient repeats something you've said during the midst of the "seizure"

Up Vote Up Vote ×
+ Join the Discussion