Behavioral Health Emergencies

Question 1

Although you cannot determine what has caused a person’s crisis, you may be able to predict whether a person will become ___

Answer 1

Violent

Question 2

What you can see of a person’s response to the environment

Answer 2

Behavior

Question 3

Stress is managed by the use of ___

Answer 3

Coping mechanisms

Question 4

Describes the situation involving patients of all ages who exhibit agitated, violent, or uncooperative behavior or who are a danger to themselves or others

Answer 4

Behavioral crisis

Question 5

The basic activities a person usually accomplishes during a normal day, such as eating, dressing, and bathing

Answer 5

Activities of daily living

Question 6

A persistent feeling of sadness and despair

Answer 6

Chronic depression

Question 7

Depression may be a symptom of an underlying ___

Answer 7

Health disorder

Question 8

When a behavioral health emergency arises, patients may show ___

Answer 8

Agitation or violence or become a threat to themselves or others

Question 9

A behavioral health emergency is more serious than a typical ___ that causes inappropriate behavior

Answer 9

Behavioral crisis

Question 10

When there is an immediate threat to the person involved or when a patient’s behavior threatens you, family, friends, or bystanders, the situation should be considered a ___

Answer 10

Behavioral health emergency

Question 11

An illness with psychological or behavioral symptoms that may result in impaired functioning

Answer 11

Psychiatric disorder

Question 12

Most common mental health disorders

Answer 12

Anxiety disorder

Question 13

Includes generalized anxiety disorder, panic disorder, and social and other phobias

Answer 13

Anxiety disorder

Question 14

Has specialized training dealing with more complex psychological conditions

Answer 14

Pyschologist

Question 15

For the treatment of the most severe conditions, such as schizophrenia or bipolar disorder, a ___ may need to prescribe medication

Answer 15

Psychiatrist

Question 16

Two basic categories of diagnosis that a physician will use for a behavioral crisis or emergency

Answer 16

1. Organic (physical)
2. Functional (psychological)

Question 17

Temporary or permanent dysfunction of the brain caused by a disturbance in the physical or physiological functioning of brain tissue

Answer 17

Organic brain syndrome

Question 18

Causes of organic brain syndrome include ___

Answer 18

1. Sudden illness
2. Traumatic brain injury
3. Seizure disorders
4. Drug and alcohol abuse
5. Overdose
6. Withdrawal
7. Diseases of the brain, such as Alzheimer dementia or meningitis

Question 19

Altered mental status can arise from a physiological issue such as ___

Answer 19

1. Hypoglycemia
2. Hypoxia
3. Impaired cerebral blood flow
4. Hyperthermia
5. Hypothermia

Question 20

In the absence of a physiologic cause, altered mental status may be an indicator of ___

Answer 20

A psychiatric disorder such as bipolar disorder

Question 21

A physiologic disorder that impairs bodily function when the body seems to be structurally normal

Answer 21

Functional disorder

Question 22

Schizophrenia, anxiety conditions, and depression are good examples of ___ disorders

Answer 22

Functional

Question 23

A disorder where something has gone wrong, but the root cause cannot be identified

Answer 23

Functional disorder

Question 24

The chemical or physical basis of these disorders does not alter the appearance of the patient

Answer 24

Functional disorder

Question 25

A patient displaying bizarre behavior may actually have ___ that is the cause, or partial cause, of the behavior

Answer 25

Acute medical illness

Question 26

Safety guidelines for a behavioral health emergency

Answer 26

1. Assess the scene 2. Ensure you have a means of communication, such as a radio 3. Know where the exits are 4. Don appropriate PPE 5. Have a definite plan of action 6. Urgently deescalate the patient's level of agitation 7. Calmly identify yourself 8. Be direct 9. Be prepared to spend extra time 10. Stay with the patient 11. Do not get too close to a potentially volatile patient 12. Express interest in the patient's story 13. Avoid fighting with the patient 14. Be honest and reassuring 15. Do not judge

Question 27

When working with a potentially volatile patient, position yourself at at ___ angle

Answer 27

45°

Question 28

Begin your assessment from the ___

Answer 28

Doorway or from a distance

Question 29

Engage family members or loved ones to encourage the patient's ___

Answer 29

Cooperation

Question 30

Unless your patient is unstable from a ___, prepare to spend time with your patient

Answer 30

Medical problem or trauma

Question 31

Four major areas as possible contributors to the patient's behavioral crisis or emergency to consider during history taking

Answer 31

1. Is the patient's CNS functioning properly? 2. Are hallucinogens or other drugs or alcohol a factor? 3. Are significant life changes, symptoms, or illness (caused by mental rather than physical factors) involved 4. If a patient has a history of behavioral health illness, has there been a recent change in medications?

Question 32

Specific questions to ask during the SAMPLE history to pass to the hospital staff

Answer 32

Previous episodes, treatments, hospitalizations, and medications related to behavioral symptoms

Question 33

In geriatric patients, consider ___ as possible causes of abnormal behavior

Answer 33

Alzheimer disease and other causes of dementia

Question 34

History taking assessment has two primary goals

Answer 34

1. Recognizing major threats to life 2. Reducing the stress of the situation as much as possible

Question 35

A technique used frequently by mental health professionals to gain insight into a patient's thinking

Answer 35

Reflective listening

Question 36

Involves repeating in question form, what the patient has said, encouraging the patient to expand on his or her thoughts

Answer 36

Reflective listening

Question 37

Obtain vital signs only if you are able to do so without worsening your patient's ___

Answer 37

Emotional condition

Question 38

A patient who has a blank gaze or rapidly moving eyes may be experiencing ___

Answer 38

CNS dysfunction

Question 39

In many patients with autism, making eye contact can ___

Answer 39

Be very stressful and may cause the patient to become agitated

Question 40

If you feel transport may put you at risk, ___

Answer 40

Ask LE personnel to accompany you

Question 41

If a police officer restrains the patient with handcuffs, the officer must ___

Answer 41

Ride in the back of the ambulance to release the cuffs in case of an emergency

Question 42

Placing the stretcher in the ___ position helps prevent aspiration and reduces physical exertion by relaxing the abdominal muscles

Answer 42

Fowler or high Fowler

Question 43

If restraints are necessary, reassess the patient's ___ every ___

Answer 43

1. Respirations, pulse, motor and sensory functions in all restrained extremities 2. 5 minutes

Question 44

If the patient is spitting ___

Answer 44

Place a surgical mask loosely over their mouth and wear appropriate PPE

Question 45

State of delusion in which the person is out of touch with reality

Answer 45

Psychosis

Question 46

Common causes of psychosis

Answer 46

1. Mind-altering substances 2. Intense stress 3. Delusional disorders 4. Schizophrenia

Question 47

A complex disorder that is not easily defined or easily treated. It affects how a person thinks, feels, and behaves

Answer 47

Schizophrenia

Question 48

Schizophrenia's onset typically occurs during ___

Answer 48

Early adulthood, between the ages of 16 and 30 years

Question 49

Symptoms of schizophrenia

Answer 49

1. Delusions 2. Hallucinations 3. Paranoia 4. Lack of interest in pleasure 5. Erratic speech

Question 50

Guidelines for dealing with a psychotic patient

Answer 50

1. Determine the danger 2. Clearly ID yourself 3. Be calm, direct, and straightforward 4. Maintain an emotional distance 5. Do not argue or go along with delusions 6. Explain what you would like to do 7. Involve people the patient trusts

Question 51

A condition of impairment in cognitive function that can present with disorientation, hallucinations, or delusions

Answer 51

Delirium

Question 52

A behavior characterized by restless and irregular physical activity

Answer 52

Agitation

Question 53

Also known as agitated delirium or exhaustive mania

Answer 53

Excited delirium

Question 54

Common physical symptoms of excited delirium

Answer 54

1. Hypertension 2. Hyperthermia 3. Tachycardia 4. Diaphoresis 5. Dilated pupils

Question 55

Physical agitation can lead to sudden death, thought to result from ___

Answer 55

Metabolic acidosis

Question 56

Occurs when a patient's physical position restricts chest wall movements or causes airway obstruction

Answer 56

Positional asphyxia

Question 57

Protocols should include only the use of restraint devices that have been ___

Answer 57

Approved by the state health department or local EMS agency

Question 58

EMS protocols should avoid the use of ___ restraints if possible

Answer 58

Hard

Question 59

The method of restraint chosen should be the ___

Answer 59

Least restrictive method that will ensure the safety of the patient and providers

Question 60

Ideally ___ people should be present to carry out the restraint

Answer 60

5

Question 61

Position to restrain a physically uncooperative patient

Answer 61

Supine, with one arm up and one down, the head elevated at a 30° angle

Question 62

Physical restraint should be reserved for situations where ___ restraint is unavailable

Answer 62

Chemical

Question 63

Risk factors to assess the level of danger of a combative patient

Answer 63

1. History 2. Posture 3. The scene 4. Vocal activity 5. Physical activity

Question 64

Other factors to consider in assessing a patient's potential for violence

Answer 64

1. Poor impulse control 2. History of truancy, fighting, and uncontrollable temper 3. History of substance abuse 4. Depression 5. Functional disorder

Question 65

Single most significant factor that contributes to suicide

Answer 65

Depression

Question 66

Can occur after exposure to, or injury from, a traumatic event

Answer 66

Posttraumatic stress disorder (PTSD)

Question 67

Symptoms of PTSD

Answer 67

1. Feelings of helplessness 2. Anxiety 3. Anger 4. Fear

Question 68

Uncontrollable events triggered by a sound, sight, or smell

Answer 68

Flashbacks

Question 69

Occurs when a person attempts to escape from constant internal distress or a particularly disturbing event

Answer 69

Dissociative PTSD

Question 70

Only with the concurrence of ___ can the patient be taken into custody with an emergency petition

Answer 70

Medical control