ALOC & Psych Flashcards

Question

Glasgow coma scale motor- 6 pts

Answer 1

``` obeys commands 6 localizes 5 withdraws 4 flexes 3 extends to pain 2 none 1 ```

Answer 2

awakes verbal pain unresponsive

Answer 3

``` ALOC protocol urine: blood, infxn, ketones CBC wi/ diff, chem pnl total CK- rabdo Mg2+ Tylenol, ASA level (OD's) Rx med levels (esp Sz meds, digoxin) TSH, RPR in new psychosis consider lactic acid if fever, HoTN EKG ```

Answer 4

trauma new delirium w/o cause or any new psychosis HIV, CA + ALOC

Answer 5

fever & ALOC HIV & ALOC consider in new delirium/ psychosis

Answer 6

``` Good to do! agitated pt's delirium alcohol tox ```

Answer 7

monitor VS & mental status changes visit sedated pts often! document course recognize if getting worse/ better

Answer 8

can this be reversed? now? protect the pt, staff. get ctrl assume ALOC is medical until proven otherwise serial VS & exams are KEY prove to yourself the "drunk" is just drunk- beware the "frequent flyer"

Answer 9

suicidal homicidal gravely disabled- cannot care for self

Answer 10

must r/o any medical/organic cause psych facility is NOT an acute medical facility- we must do the medical work purely psychiatric cause of ALOC is a dx of exclusion

Answer 11

``` Dx established stable, no medical issues at transfer pt is able to talk to psychiatrist practitioner to practitioner transfer arrange transportation (BLS) inform pt & family ```

Answer 12

``` ABCDE's, VS, sick vs. not sick protect pt, staff Hx- detective work Mental status exam/ orientation PE lab, diagnostics Dx disposition ```

Answer 13

``` past med hx- prior psych hx? med problems? meds- big clue- are you taking them? OTC, CAM Habits- anything today? ROS- focus on the biggies Social Hx: life stressors, events, living situation has anyone hurt you lately? is there anyone i should call? ```

Answer 14

Do you want to hurt yourself or anyone else? Are you feeling suicidal now? Have you thought about how you would do it? Do you have: gun, access to pills, etc...? Have you ever tried to hurt yourself before? Are you hearing voices? What are they saying? Are you seeing anything unusual?

Answer 15

``` VS general appearance head to toe exam- get permission mini-mental status/ orientation doc. if pt unable/unwilling to cooperate may need to examine after sedation serial exams ```

Answer 16

``` no previous psych hx age>40- 1st psych issue abnormal VS recent memory loss, trauma impaired consciousness -u suspect an organic, not functional etiology of this behavior change ```

Answer 17

``` ALL- D-stick, breathalyzer, UPT, Utox Specific: CBC, Chem pnl, UA Rx drug levels, Tylenol, ASA TSH, RPR, B12 EKG, CXR consider CK-esp. w/ stimulants consider lactate- fever, infxn consider head CT, lumbar puncture ```

Answer 18

soft restraints leathers belts mask

Answer 19

``` Benzos Midazolam (Versed) 2-5 mg IM/IV Lorazepam (Ativan) 1-2 mg IM/IV Antipsychotics Ziprasidone (Geodon) 10-20 mg IM, 20 mg PO Haloperidol (Haldol) 2-5 mg IM/IV add Cogentin 1-2 mg IM/IV, EPS ```

Answer 20

``` restrain pt w/ other staff remove restraints w/ other staff present Never remove restraints from any pt you do not know restrained pt's must be supervised contract with pts- beware ```

Answer 21

``` male, white, unemployed, single adolescents drug &/or alcohol abuse recent life stressor physical/chronic illness hx of domestic violence, sexual assault/abuse major mood d/o's, 10% schizophrenic pts lethality/ rescue ratio of plan past attempt, family hx of suicide ```

Answer 22

``` recognition, assess risk, 5150? suicide precautions in ED restraints, high visibility area, "clean" area medically clear monitor, tx, consider OD repair lacerations, etc psych consult admit/transfer to psych facility transfers must be stable ```

Answer 23

``` psychiatric consultation obtained not suicidal now risk profile low intent, gesture for secondary gain pt has family, friends here, now pt has stable home environment can f/u w/ psychiatrist reliably means of lethality eliminated/ regulated ```

Answer 24

``` MC human psychiatric disturbance- situation, illness, meds, drugs MC underlying cause of suicide most costly to society genetic disposition modern complications media, world events immigrant displacement ```

Answer 25

``` Sadness Insomnia/Hypersomnia Guilt Mood Energy Concentration Appetite, activity Pleasure (anhedonia) Suicide ```

Answer 26

pt a danger to self? others? need a 5150? organic vs. functional vs situational? diagnostics ALOC protocol, add TSH disposition based on severity suicide risk, ability to care for self, support ED rarely initiates medical therapy (2 wk rule) Discuss therapies- drugs help, medical model

Answer 27

distinct period of abnormality, persistently elevated, expansive or irritable mood, lasting at least a week psychiatric, medical, meds, drugs

Answer 28

``` pt a danger to self? others? protect pt, protect staff chemical restraint often needed-Benzo's good hx/ PE- get info medical workup if new, unstable ALOC protocol, add EKG, TSH, CK psychiatric consult, 5150? ```

Answer 29

really common; fear of illness cardiac- MI, CHF, dysrhythmias endocrine- thyroid respiratory- PE, asthma, COPD

Answer 30

``` sympathomimetics caffeine herbals cannabis LSD ecstasy benzo's ```

Answer 31

mania depression schizophrenia

Answer 32

``` pt a danger to self? others? evaluate in quiet area, reassure, listen good hx, good PE ALOC protocol EKG if tachy, CP; TSH Tx: Benzo's IV/IM/PO Psych consult, primary care referral Home, family, friends Benzo Rx only for 3-5 days max if d/c ```

Answer 33

s, substance abuse recent stressors poor social support/situation no regular psych tx

Answer 34

``` danger to self? others? 5150? protect the pt, staff may need chemical restraint, tx benzo's geodon, haldol to tx sx's- voices, agitation good hx/ PE- get info new= medical work-up not new? what caused this change? psych consult, follow-up ```

Answer 35

``` Dystonic rxn Buccolingual, oculogyric, neck Benadryl- acute IV, outpt PO Tardive Diskinesia involuntary: lips, face, extemities Orthostatic HoTN Neuroleptic Malignant Syndrome Serotonin syndrome ```

Answer 36

``` ALOC fever "lead pipe" rigidity autonomic instability rare-sick-admit ```

Answer 37

``` ALOC fever tremor/shakes rigid LE's hyperreflexia ```

ALOC & Psych Flashcards

(62 cards)