Agitated Patient Flashcards

1
Q

What are the risks that need to be assessed on triage of the agitated pt in ED?

A
  • Risk of suicide /self harm
  • Risk of aggression to others
  • Risk of absconding
  • Risk of intoxication
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2
Q

Common diagnoses in presentation of acute agitation?

A
  • Acute psychotic episode
  • Acute manic episode
  • Drug induced psychosis (esp amphetamines)
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3
Q

Aetiology of acute behavioural emergencies?

A

i) Drug affected pts: alcohol of sympathomimetic agents
ii) psychiatrically disturbed pts
iii) Extreme anti social / personality disordered pts
iv) medical conditions precipitating acute delirium

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4
Q

Why is physical/ chemical restraint a step requiring caution?

A

You are removing someone from their legal rights; all caution should be taken to consider available treatment options before chemical sedation.

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5
Q

Management of hostile, frightened pts?

A

Hostile, frightened, uncooperative pts often require rapid tranquilisation; pharmacological treatment must be tailored to the pt.

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6
Q

First line agents for rapid tranquilisation?

A
  • try to develop rapport

- PO benzos: diazepam 10mg / clonazepam 2mg

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7
Q

Route of administration for rapid tranquilisers?

A

-Depends on pts condition

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8
Q

Mx of sedated pts?

A
  • Monitoring: oximetry, haemodynamics, RR, BSL.

- Supportive care: hydration, IDC, pressure, DVT prophylaxis

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9
Q

Risks of rapid tranquillisation?

A
  • Injury to staff and pt
  • Physical injury from restraint
  • Over sedation and resp depression,
  • hypotension
  • aspiration
  • SCD (prolonging QT precipitating VT)
  • Anticholinergic effects (e.g. delirium and AUR)
  • Delirium
  • Lowered seizure threshold
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10
Q

Tranquillisers ass/w prolonged QT?

A
  • Thioridazine and clozapine
  • Quetiapine and chlorpomazine
  • Onlanzapine appears to be relatively safe
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11
Q

Features of midazolam?

A
  • IM or IV
  • Rapid effects (2-5mins)
  • Fewer AEx than diazepam
  • Elimination T1/2 prolonged in elderly (titrate dose)
  • Can start with 2mg
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12
Q

Features of diazepam?

A
  • PO or IV (nil IM)

- Prolonged terminal elimination (up to 20h)

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13
Q

Features of clonazepam?

A
  • PO, IV or IM

- Elimination T1/2 = 20-50h

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14
Q

AEx haloperidol?

A
  • Extrapyramidal effects

- Prolonged QT

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15
Q

Haloperidol delivery?

A

PO, IV or IM

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16
Q

Ix after sedation?

A
  • FBE: Hb, WCC
  • UEC: risk of QT changes
  • LFTs: risk of EtOH/drug in population
  • BSL
  • ECG
  • Paracetamol level
  • EtOH level
  • bHCG
  • ?Blood culture
  • CT Brain
17
Q

Third line treatment of acute agitation in ED?

A
  • Diaz 2.5-5mg IV
  • Clonazepam 1-2mg Im or IV up to 8mg daily
  • Haloperidol 2.5-5,g IM or IV
  • Chlorpromazine
18
Q

Ddx of acute psychosis?

A
  • Primary psychotic disorder: e.g. schizophrenia
  • 2” to medical condition: e.g.delirium
  • Drugs / meds (e.g. anticholinergics, steroids)
  • Infectious (CNS)
  • Metabolic (hypoglycemia, hepatic, renal, thyroid)
  • Structural (haemorrhage, neoplasm)
19
Q

Strategies for violence prevention when managing an agitated patient?

A
  • Remain calm, empathic and reassuring
  • Ensure safety of staff and pts
  • Call security/staff if req’d
  • Restraint or chemical tranquillisation if required
20
Q

Persons at high risk of suicide?

A
SADPERSONS
Sex = male
Age >45
Depression
Previous attempts
EtOH use
Rational thinking loss
Suicide in family
Organised plan
No spouse / support
Serious illness
21
Q

Prodromal signs indicating violence?

A

-Anxiety, restlessness, defensiveness, verbal attacks