Pseudo-seizures and stolen topics

Mark Glencourse (Medic999) wrote a very interesting blog today. It made me and his other readers think and laugh a bit (I think MsParamedic piddled her pants). I realized that the comment I made was a bit lengthy and full of Jake, so here it is:

MedicJake:
Great post, Mark. I've never worked outside of California, but I'm guessing that every medic in an urban/metro system eventually encounters that call. I've seen partners handle the same circumstance very differently, sometimes based on knowledge and experience, and sometimes tragically based on burnout and fatigue.

I always try to over-triage if there is any question. If I'm not sure, I give the pt the benefit of the doubt, and at least don't chastise them during their performance. With the strange atypical seizures that you mentioned, that are at least common enough for us to occasionally encounter, there's only one way to be sure; portable EEG. A patient can be the best actor in the world, but brainwaves don't lie. The technology exists, and is used in other areas of healthcare, just not EMS.

The day will come when our cardiac monitor, EEG, portable ultrasound, blood analyzer, other diagnostic tools and the charting computer will all be integrated into something nearly pocket-size, like a Star Trek tricorder (Geek? Yes.), and we'll all be educated and trained to use them. People scoffed over the idea of a telephone, a TV, a VTR ( a what?), a stereo, and a personal computer all being the same posket-size device, that wouldn't need any wires to hook it up, and could store every song and movie you've ever heard or watched or even wanted to, and guess what - I'm bloggin on one right now. I can't wait to see how the technology changes over the next few decades.

Where I work we have a frequency of "acute mood disorders" that tend to have higher prevalence among certain ethnicities, which of course lends them the same kind of inappropriate and derogaatory acronyms and nicknames that medics tend to assign things. Anyhow, it seems that the most effective treatment for these emotional emergencies also tends to work on many pseudo-seizures; remove the audience, and the performance stops. If not, then like a crying baby they'll stop eventually, or you'll find out that they have tourette's syndrome or a brain tumor and look like a...gosh darn fool...

You hit the nail on the head I think though with your mentioning things like patterns of movement, incontinence, facial muscle activity, and other the little hints that without being able to analyze a brain's electrical activity in the field are our best diagnostic tools. Our minds and bodies are very reliable tools, and I hope that even once we get new technology in the field that medics will maintain their ability to assess patients excellently without technology at their aid.

Medic999:
Thanks for the comment Jake!

I like the idea of a portable EEG!!

I have a consultant at my local hospital who wants us to start using Ultra Sound Fast Scans in the prehospital environment. Im sure it would be here already if they werent so damn expensive!

MedicJake:
I recall seeing an article in JEMS about a small EMS system in the US using portable ultrasound fast scans in the field. I think it was somewhere in the midwest, possibly Ohio. I'll look for the article. The medics all got special training from physicians in how to interpret the images to look for findings in trauma patients that would justify trauma pre-alerts. I think it was supposed to be a trial study to see if it had an effect on over-triage and under-traige of trauma activations. Of course the cost is the biggest issue. It will be a long time before most of us will ever see them.

MedicJake:
Temple Terrace, Florida.
http://northeast2.tbo.com/content/2009/nov/04/ne-local-paramedics-get-new-diagnosis-tool/

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