Chapter 23 Behavioral and Psychiatric Emergencies and Suicide Flashcards
Key Terms
the manner in which a person acts
Behavior
Key Terms
when a patient’s behavior is not typical for the situation; when the patient’s behavior is unacceptable or intolerable to the patient, his family, or the community; or when the patient may harm himself or others
Behavioral Emergency
Key Terms
bizarre and/or aggressive behavior, shouting, paranoia, panic, violence toward others, insensitivity to pain, unexpected physical strength, and hyperthermia, usually associated with cocaine or amphetamine use. Also called “agitated delirium”
Excited Delirium
Key Terms
inadequate breathing or respiratory arrest caused by a body position that restricts breathing
Positional Asphyxia
Critical Decision Making
How would your assessment determine if the following patient is suffering from a medical problem or a psychiatric problem? Your patient is a fifty-six-year-old man who was found to be “talking to God” and generally mumbling at the grocery store.
In this case a stroke or diabetic emergency could cause similar symptoms. Obtain a history from the patient, and observe for medical alert identification. If you have the ability to perform blood glucose measurement, do so. A stroke scale may be helpful if the patient is cooperative. A history of head injury or other cause of altered mental status should be explored.
Critical Decision Making
How would your assessment determine if the following patient is suffering from a medical problem or a psychiatric problem? Your patient is a twenty-one-year-old student who was found on the outskirts of his campus, acting strangely, with a slight smell of alcohol on his breath.
Alcohol may have caused the emergency, but it isn’t the only potential cause. Perform a thorough history and a blood glucose measurement. Stroke isn’t as likely in a twenty-one-year-old. Consider drug use in addition to alcohol and diabetes. Also look for evidence of head injury or seizure history.
Critical Decision Making
How would your assessment determine if the following patient is suffering from a medical problem or a psychiatric problem? Your patient is an eighty-four-year-old woman who is in a nursing home. She has history of depression and cardiac problems. This morning she became agitated and angry with the staff.
Depression won’t normally cause aggressive behavior. Dementia or Alzheimer’s may. Look for a history of this as well as compliance with her medications. Look for evidence of seizure, head injury, or diabetes. You may not be able to perform a stroke scale, but observe for signs of asymmetry in speech or for movement that is new to the patient.
Short Answer
Name several conditions that can alter a person’s mental status and behavior.
A number of medical conditions can alter a person’s mental status and behavior, including low blood sugar, lack of oxygen, inadequate blood to the brain or stroke, head trauma, mind-altering substances, excessive cold, excessive heat, and psychological conditions.
Short Answer
List several methods that can help calm the patient who is suffering a behavioral or psychiatric emergency.
A number of methods will help calm a patient suffering from a behavioral or psychiatric emergency. Always speak slowly and calmly. Use a calm and reassuring tone. Listen to the patient, and make him aware of this. Do not be judgmental. Show compassion, not pity. Use positive body language; avoid crossing one’s arms or looking disinterested. Acknowledge the patient’s feelings. Do not enter the patient’s personal space; instead, stay at least 3 feet away.
Short Answer
Describe the signs and symptoms of a behavioral or psychiatric emergency.
Some of the signs and symptoms of behavioral or psychiatric emergency include panic or anxiety; unusual appearance, disordered clothing, and poor hygiene; agitated or unusual activity; and unusual speech patterns or inability to carry on a coherent conversation.
Short Answer
Describe what you can do when scene size-up reveals that is is too dangerous to approach the patient.
When your scene size-up reveals that it is too dangerous to approach a patient, always call for police and wait for them. Do not leave the patient alone. Try to talk to the patient from a safe distance.
Short Answer
List several factors that can help you assess the patient’s risk for suicide.
A number of factors can help you assess a patient’s risk for suicide, including previous threats of suicide; depression; high current or recent stress levels; previous attempts or suicide threats; a suicide plan; recent emotional trauma; age (fifteen to twenty-five and over forty are at greater risk); alcohol and drug abuse; sudden improvement from depression.
Short Answer
Research your state law. Then describe the circumstances that must exist for you to treat and transport a behavioral emergency patient without consent.
Answers will vary depending on your state laws. In most states a patient cannot be transported against his will without a legal document or psychiatric hold authorizing the transport. In some cases these can be signed by only a judge; in other cases they can be signed by law enforcement and physicians.
Critical Thinking
You are transporting a psychiatric patient who was restrained by the police. The patient was highly agitated but now begins to act sleepy. Should you reassess the patient? If so, how?
This could be a case of excited delirium, a very dangerous situation in which a patient will act extremely agitated or psychotic. This situation is thought to be due to drug intoxication or elevated temperature. The patient will suddenly cease struggling; often within minutes, the patient begins breathing inadequately and subsequently dies. Meanwhile, law enforcement and rescuers think the patient finally just “calmed down” and may fail to reassess. Always be alert for this sequence of events if patients exhibit this behavior, and monitor the patient closely throughout the call. Have plenty of help, plan your activities, and always place the patient faceup.
Short Answer
You are called to respond to an intoxicated minor who is physically aggressive, threatens suicide, and whose parents permit you to treat but not transport. How would you manage this patient?
Be aware of your state laws regarding involuntary restraint and transportation of minors. Most states have laws that allow a patient to be transported against his will if he is a danger to himself or others. If the parents do not give permission to transport the patient, it will be helpful to contact medical direction and call for a law enforcement response for the safety of yourself, the patient, and the parents, and to help avoid liability problems if you attempt transport on your own.
