Seize the Seizing

Tonight I am on call and while I was getting ready to admit a new patient with pneumonia I was reviewing the chart in the nursing station. All of a sudden the nurses began to panic and one of them yelled for a doctor and said that her patient was seizing. I continued to review my chart but soon realized that I was the closest thing to a doctor on the whole floor. The charge nurse realized this as well and said "doctor, you have to run a code!" 

I ran to the room and began to bark out orders and questions like "get me a crash cart", "Tell me what meds she is on", etc. The patient was writhing back and forth and moaning. The nurse said the patient was having a seizure and had a history of seizures. I did not think that this looked like a seizure so I did a sternal rub to see her response to pain and I noticed that she was guarding and trying to avoid the pain. Next I forced her eyes open with my fingers to see if her eyes had rolled back in her head and to see if her pupils where responsive. I immediately saw that her pupils were reactive and they were not rolled back. I quickly determined that this was not a seizure but rather she was malingering (faking). While holding her eyes open I looked her in the eyes and yelled "you are not having a seizure, knock it off". Almost immediately she sat up and quit the writhing and shortly after this she requested to use her cell phone. If she had been having a seizure she would have been postictal and would not have been able to function enough to request to make a phone call. The nurses were impressed and asked me how I knew she was not having a seizure. I explained how seizures work and described the methodology of determining if a patient is having a seizure. 

I returned to admitting my patient and enjoyed the effects of the adrenaline rush. The hospital is never boring.