Folks in the ED — when assessing a patient with suspected non-epileptiform events (pseudoseizures), it is never appropriate to apply noxious stimuli as a test. Do not nipple twist, sternal rub, compress nail beds, etc.. If you are concerned about the airway, perform a jaw thrust. If you are concerned about seizures, treat as such. If the exam is confusing enough that you can’t be sure, get an EEG (which means admit most places).

#emergencymedicine #neurology #PNEE