224 Psychiatric Emergencies

Question 1

Definition of psychosis (per Naples)

Answer 1

Condition of the mind broadly defined as a loss of contact with reality. It is the manifestation of an underlying disease process

Question 2

What are the 4 categories of psychotic symptoms?

Answer 2

Disorganized thought
Hallucinations
Delusions
Agitation

Question 3

What are the 4 underlying causes of psychosis?

Answer 3

Substance induced psychosis
Medical or neurological conditions (hypo/hyperglycemia, hypoxia, hypercapnea, decreased cerebral perfusion, seizures, infections, electrolyte abnormalities),
Delirium
Primary psychiatric illness

Question 4

What are some common side effects of first generation antipsychotics?

Answer 4

EPS and movement disorders
Electrolyte imbalances
NMS development
Prolonged QT

Question 5

What is the benefit of using a second generation antipsychotic instead of first generation?

Answer 5

Doesn’t cause EPS/movement disorders

Question 6

Describe a low risk psych patient

Answer 6

-usually not certified
- can be PCP escort
- can have some mild sedation (1-2 mg ativan, 50 mg Gravol)
- don’t have to be restrained

Question 7

Describe a medium risk psych patient

Answer 7

• may or may not be certified
• physical restraints are mandatory
• must be restrained for entire duration of flight

Question 8

Describe a high risk psych patient

Answer 8

• sectioned
• IV sedation with EEG and ETCO2 monitoring
• physically restrained

Question 9

What are the 3 categories assessed by the BC-PRAT tool?

Answer 9

Emotional
Mental
Behavioural

Question 10

What is the deepest level of sedation you should target for a psych patient that you are not intubating and why? (RASS goal)

Answer 10

3
4-5 is too deep - concern for airway