psychiatric emergencies Flashcards
1
Q
behavioral emergency*
A
- some disorder of mood, thought, or behavior that interferes with activities of daily living (ADLs)
- physiological response of emergent
- emergent nature to you and your lifestyle -> not necessarily emergency care
- ex. OCD
- BH- behavioral health
2
Q
psychiatric emergency*
A
- behavior that threatens a persons health or safety and the health and safety of another person
- danger to self and others
- ex. someone threatening to stab someone else and themselves
3
Q
four broad categories of abnormal behavior
A
- biologic or organic in nature- ex. schizophrenia
- resulting from the environment- ex. stressors, torture
- resulting from acute injury or illness- ex. acute brain injury
- substance-related- could be illegal or legal (in excess), combining drugs
4
Q
biologic or organic causes of abnormal behavior
A
- organic brain syndrome
- conditions alter the functioning of the brain
- dementia
- Alzheimer’s
- not external
- brain tumor
- use medication to get back to normalcy -> need to take that medication continuously
5
Q
environmental causes of abnormal behavior
A
- psychosocial and sociocultural influences
- when consistently exposed to stressful events patients develop abnormal reactions -> constant stress
- sociological factors affect biology, behavior, and responses to the stress of emergencies
- constant stress impulse can alter brain chemistry
- external impulse- radiation, espestis
6
Q
causes of abnormal behavior: injury and illness
A
- illness results in stress on coping mechanisms
- acute trauma creates stress
- post-traumatic stress disorder (PTSD)
- abuse, life events
- leading cause of traumatic death caused by weapons is domestic violence
7
Q
causes of abnormal behavior: substance-related
A
- alcohol
- cigarettes
- illicit drugs
- other substances
- can be prescribed medications in excess or mixed together
8
Q
emergency medical care
A
- if the erratic behavior could be caused by a medical disorder:
- treat that before presuming the behavior is due to an emotional or psychiatric cause
- assume that any erratic or unusual behavior is medical cause until proven otherwise **
- medical causes of unusual behavior are more death inducing in an acute phase than psychiatric emergencies -> faster and more frequent***
9
Q
communication techniques
A
- verbal de-escalation- don’t need hands, tools, just listen and maintain composure, acknowledge, make them feel heard
- active listening
- begin with an open-ended question
- let there patient talk
- listen, and show that you are listening
- dont be afraid of silence
- acknowledge and label feelings
- dont argue
- facilitate communication
- direct the patients attention
- do not engage in confrontation -> this solves nothing
10
Q
what do you do when someone is talking
A
you are either: -listening -planning the next thing you will say ,or -you don't care
11
Q
physical restraint
A
- improvised or commercially made devices
- lead to high amount of untourt deaths -> not checking vital signs after restraint *
- be familiar with restraints used by your agency
- make sure you have sufficient personnel
- restraining someone causes damage to skin, genitals, and vasculature
- continuously monitor the patient
- never place your pt face down -> positional asphyxia
- check peripheral circulation every few minutes
- be careful if a combative pt suddenly becomes calm
- document everything in the patients chart
- you may defend yourself against an attack
- minimum of four trained, able bodied people (for each limb)
- discuss the plan of action before you begin
- include law enforcement when appropriate
- use the minimum force necessary
- dont immediately move toward the patient
12
Q
chemical restraint
A
- use of medication to subdue a patient
- alter consciousness to make the situation calmer
- benzodiazepine- sedative- very common -> used for seizures
- these medication may also cause vasodilation, bronchodilation, apnea, respiratory distress -> be aware of ALL effects
- RASS score
- closely monitor the patients:
- pulse rate
- blood pressure
- respiratory rate
- be prepared to support ventilation
13
Q
RASS score
A
- Richmond agitation sedation scale***
- from +4 to -5
- scales how excited someone is to how calm
- -1–2 light sedation
- not trying to comatose
- 5 combative
- -5- unconscious
14
Q
agitated delirium pathophysiology
A
- Delirium: a state of global cognitive impairment
- Dementia: more chronic process
- Patients may become agitated and violent
- physiological signs- high heart rate, rapid breathing, excessive sweating, high blood pressure
- agitated delirium requires a physical exam bc of this
15
Q
agitated delirium assessment
A
- try to reorient patients
- perform a thorough assessment
