Psych

Question 1

repeat ED users

Answer 1

Schizophrenia pts

Question 2

Components of a mental status exam in the ED

Answer 2

Behavior, Affect, Orientation, Language, Memory, Thought content, Perceptual abnormalities, Judgement

Question 3

basic lab studies for a suspected psych pt that can help r/o other organic disease

Answer 3

CBC, Chem 7, LFT’s, EKG, CXR, Tox studies, +/- CSF and CT

Question 4

Lab studies required for a psych pt

Answer 4

if the pt is stable, and the complaint is primarily psych, evaluation should be focused on the history and PE, not on lab results. If pt is Alert and cooperative, do not even need to order tox screen- is NOT recommended.

Question 5

antipsychotic drug of choice in the ED

Answer 5

Haldol. beware- can cause dystonia

Question 6

Antipsychotic dosing in the ED

Answer 6

Haldol 5 mg IV q 15 mins until agitation is controlled. Can start with 2 mg IV and double the dose every 45 mins until controlled, but this is off label use.

If there is not an IV in place can give IM haldol 2-5 mg q1hr.

Question 7

amount of antipsychotic to not exceed in ED

Answer 7

Do not exceed 20 mg haldol/day

Question 8

antipsychotic additive that can be used to more rapidly control agitation

Answer 8

Can add lorazepam (ativan), which works synergistically with Haldol. 1-2 mg IV or IM

Question 9

when pt displays violent behaviour

Answer 9

that demands an immediate restraint in the ED

Question 10

Number of people necessary for applying physical restrains

Answer 10

6- one for each limb, one for the head and one to actually apply apply the restraint

Question 11

contraindications for 4 point restraint

Answer 11

pt is competent and refusing care, pt is not a danger to self or others, or when less restrictive alternatives have not been attempted

Question 12

removing restraints

Answer 12

should not be done all at once- go from 4–> 2–> 1

Question 13

continuing restraints

Answer 13

they need to be ordered and reordered every 4 hours with documented reasoning for restraints

Question 14

involuntary psych hold

Answer 14

if the provider has reasonable belief that the pt is at immediate risk of harm to self or others and the pt is not consenting to treatment, the pt can be held against their will in the ED for at least 12 hours, a maximum of 72 hours to allow for psych evaluation and treatment to commence

Question 15

Documentation of physical abuse in the ED

Answer 15

when possible, take pictures of the injuries presented to the ED. One should include the pt’s face. include reference object (like a ruler) for size. Be sure to have consent for this.

Question 16

Timeline for using a rape kit

Answer 16

must be within 72 hours of the assault

Question 17

injuries that are pathognomonic for abuse

Answer 17

loop marks, forced immersion burn pattern, raccoon eyes, bleeding from ears, retinal hemorrhage.

Question 18

bruises that raise concern for abuse

Answer 18

bruising that involves multiple areas of body beyond bony prominences, bruising of ears, cheeks, buttocks, palms, soles, neck and genitals, bruising that is all at multiple stages of healing, bruising in a nonambulatory child, bruising that resembles an object

Question 19

in a child under 5 yo with suspected abuse, what screening is indicated?

Answer 19

abdominal injury screening

Question 20

Abdominal injury screen

Answer 20

AST/ ALT, amylase, lipase, UA, stool guac