Wednesday, February 01, 2006

You Shake My Nerves and You Rattle My Brain - Emergiblog Goes Snarky

The year is 1956.

Your son is playing "cowboys and indians" with a bit of Daniel Boone thrown in. You have just completed vacuuming your entire one-story, one bathroom, formal dining room with the blond dinette set, three-bedroom tract home in the suburbs. You are sitting with a cup of coffee and reading the papers. You attended the local university for six months before receiving your Mrs. degree and have just read in the paper that Elvis may have a girlfriend. The highlight of your week is watching Bennett Cerf on "What's My Line" Sunday nights on CBS.

You just can't take it anymore!

You need Serpasil! By CIBA!

After exhaustive research (in other words, I googled it in one click), I discovered that it is an antihypertensive.

It is known generically as "reserpine".

I used to give it long ago in Coronary Care. I didn't get the connection until I read that it also works on "severe agitation in psychosis"!

Serpasil: for when the fifties weren't so nifty!


Caution! Uncharacteristic Snarky Post To Follow!

Seizures are extremely scary events to witness, be they due to pediatric fevers, not yet diagnosed brain tumors, head injuries, delirium tremens (DTs) or epilepsy. It is quite tramatic for not only the patient, but the family and witnesses as well.

They are pretty much impossible to fake. If you have ever seen one, you know what I mean.

But, in the ER, we occasionally have our share of amateurs actors and actresses who believe they can play the role well enough to win an Emmy for "Best Performance by an Actor or Actress in a Seizing Role in a Medical Drama Set in an ER".

And so...

In the interest of public service, I should like to make the following announcement:

You are not having a seizure if:
  • You can call out, "Hey Nurse! I'm having a seizure!"
  • You act like a member of the SpongeBob SquarePants Fan Club and
    • "drop on the deck and flop like a fish" .
    • Defined as: flipping your torso from side to side while lifting arms and legs three feet in the air and slamming them into the gurney.
  • You miraculously avoid all potentially harmful surfaces (like siderails) while doing the above.
  • You can speak full, coherent sentences with clear speech
    • while doing the above
    • including cussing out the staff who are trying to assist you in your distress.
  • You place your head on your arms
    • if your episode occurs on the floor
    • you are less likely to get a headache that way.
  • You only experience the above when certain significant people enter the room
    • specifically law enforcement personnel of various agencies
    • a member of the opposite sex who has decided that evening to release you from any obligations you may have had as a couple.
    • Your parents, who have just found out you and marijuana have an ongoing relationship
  • You immediately reach down to cover yourself when you realize your skirt is pulled up to your waist.
    • This is not sexist as I live in near San Francisco.
    • You can never assume who will be wearing what on any given day.
  • You experience no post-ictal alteration of your consciousness level.
    • You sit right up and marvel at how horrible your seizure experience was.
    • And did we notice how your head went up and down on the pillow, like, twenty times.

Yes, as a matter of fact, we did notice!

And now that you are through with your performance and your trillion-dollar head CT that-had-to-be-done-to-cover-everyone's-derierre has been completed, here are your discharge instructions.

Remember, we're here to help you, twenty-four hours a day.

And don't worry about that trillion-dollar CT bill. The government will add the approximately $150 a month that they they take out of my paycheck to cover your medical bills and add it to everyone else's involuntary contributions so that you won't have to worry.

You're welcome.


At 2/02/2006 04:56:00 AM, Blogger Rita Schwab - MSSPNexus said...

It's okay - everyone is entitled to be snarky once in a while.

As I recall, I was fairly snarky years ago with the mom who brought herself and her four children in to the ED because they all had the sniffles. And she certainly hoped it wasn't going to take all night to be seen...

Bet it did...

At 2/02/2006 07:14:00 AM, Blogger Flea said...

Goodness gracious great balls of fire (I just wanted you to know I got the reference, luv!)

I enjoyed your post enormously.

The most amazing thing I saw in residency was an "induced seizure" in a 16 year old girl with hysterical seizures. We injected 10 cc of saline into her IV and told her she'd have a seizure. She was hooked up to the EEG, TV monitor, the works, and we went for it.

She complied, and had a brief GTC seizure with virtually no post-ictal period. The EEG did not twitter.

We told her parents the good news/bad news. The good news is their daughter didn't have a seizure disorder. The bad news was she had much worse underlying psychopathology.

If I were her mother, I would have hoped for the former.



At 2/02/2006 07:25:00 AM, Anonymous Difficult Patient said...

If you are going to be snarky, this is the place to do it! And it sounds like the ED can be entertaining at times--although it's expensive entertainment (and I'm not referring to money only) . . .

At 2/02/2006 07:47:00 AM, Blogger Mama Mia said...

OMG, Kim - I am laughing out loud here in the nursing station - just witnessed one of these yesterday.

At 2/02/2006 10:35:00 AM, Blogger Jo said...

Snark away, Kim!
I've seen quite a few of these "seizures" on my med unit.
You're right, they are obvious when they are not a seizure.
We had one girl who knew enough to fake the post-ictal unconsciousness. That is she faked it long enough to refuse an IM med when it was mentioned.
It was annoying to be called in the room to help "protect" the faking seizure patient. But we had to, Lord knows what would have happened if we had ignored it.

At 2/02/2006 03:33:00 PM, Blogger kenju said...

I have only seen one seizure, and that was a male college classmate of mine. He was epileptic, though no one at the college knew it. He fell off his chair in the snack bar, and we were all pretty scared. He was ver embarrassed when he awoke; hoping tht no one there would ever know of his ilness. It is really sad.

At 2/03/2006 05:05:00 AM, Blogger angry doc said...

Haha. I once got an 'unconscious' teenager out of a 'conversion episode' (I hear it's politically-incorrect to call it 'hysteria' these days...) by saying out loud:

"Gee, if she doesn't wake up soon we will have to give her a jab... with the BIG needle."

At 2/03/2006 05:05:00 AM, Blogger angry doc said...

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