How to earn the rockstar ER doctor award:
- Page me to the back line to the ED
- Get put on hold for 5 minutes
- Come back and say "Sorry for the false alarm. I thought I was going to have a guy with pseudoseizures. But I got them and their family to go home."
If you could drink beer in the ED, I would have bought a keg of the finest import for that good doc that fateful night. I have taken care of several inpatients with pseudoseizures during my last six years as a hospitalist. They always have normal EEG brain wave monitoring despite very scary looking spells. They also have a clinical seizure presentation that makes no sense. In one situation, the patient would go into these hilariously funny "fits" that looked exactly like the African anteater dance.
Of course, it looks frightening to the lay person. But to the trained physician, it's painful to watch. Not because the condition is dangerous. But because often times, there is no good way to tell the family that their family member has just experienced a major psychiatric break from reality. I once had a family refuse to accept that the seizures weren't organic. They went so far as to travel hundreds of miles to "a seizure specialist" (as if Happy's neurologists came from a cracker jack box) to find out the cause of their daughter's unexplained dancing fits.
Several months later came a fully documented 5 page summary of the one week hospital stay in the video monitored EEG facility.
Diagnosis: no epileptic activity witnessed. As painful as it is, I now tell families that we have no evidence of a seizure disorder. That their shaking in all likelihood represents a psychiatric disorder, such as conversion disorder. The brain believes it's real, even though it isn't. That it is safe to go home. That you don't have to do anything if they start having their spells again. And the treatment is follow up with the psychiatrist who saw them in the hospital. It's a difficult talk, but it's the only option. The science doesn't lie.
So for you rockstar ED doc, I applaud you for preventing a wasteful $10K hospital stay for a condition that requires an outpatient psychiatric evaluation.
For good humor, check out the patient faking a seizure in the ER video.
For good humor, check out the patient faking a seizure in the ER video.
the flaw of the diagnosis is the word "pseudo" in pseudoseizures.
ReplyDeletepatients and their family thinks that means that they make it up... when in fact, they are real. just because it is in their heads (without epileptiform activity) doesn't mean its NOT real.
Docs I've worked with prefer calling it "psychogenic nonepileptic seizures" in front of patients and in correspondence but still call it pseudseizures between themselves.
ReplyDeleteThat is truly outstanding.
ReplyDeleteUnfortunately, I'm still waiting to deliver my first award of performance and excellence to the ED doc able to deliver an accurate set of vitals.
We have one... yes, count them... ONE board-certified ED doc in our arsenal. The other one we had was fired for saying some not-so-nice-but-sadly-true things about rural America during a staff meeting.
It's always nice to know your administration's priorities are in order.
Back in the days of the Ammonia inhaler, there was a good (and in the darkest part of our hearts, oddly satisfying) way to distinguish pseudoseizures.
ReplyDelete"it's painful to watch. Not because the condition is dangerous. But because often times, there is no good way to tell the family that their family member has just experienced a major psychiatric break from reality."
ReplyDeleteAmen
its the same with people with anxiety crisis, hyperventilating. family doesnt believe you that nothing is going wrong, until they go to hear 12 different opinions, and get satisfied. and they actually said yes you were right. you can talk with for 1 hour explaining them, why is not a seizure, why is not a life treating situation just hypperventilating, you might see that young lady crying and nobody knows anything, sometimes they are manipulating, conciously or unconsciously to have a secondary gain, is a phsichiatric condition. nothing that activan can cease.
We still have ammonia inhalers. And they still work like magic.
ReplyDelete