Behavioral & Psychiatric Emergencies & Suicide Flashcards Preview

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Flashcards in Behavioral & Psychiatric Emergencies & Suicide Deck (29)
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Introduction: Patients may present with unexpected or dangerous behavior which may result from?

– Stress
– Physical trauma or illness
– Drug or alcohol abuse
– Psychiatric condition


What Is a Behavioral Emergency?

• Behavior
– Manner in which a person acts or performs
• Behavioral emergency
– Abnormal behavior (in a given situation)
unacceptable or intolerable to patient, family, or community
• Behavioral patients may appear confused and have altered mental status


Psychiatric Causes of Behavioral Emergencies

• Psychiatric condition (mental disorder)
– Anxiety or panic disorder
– Depression
– Bipolar disorder
– Schizophrenia


Non-psychiatric causes of altered
mental status can be life-threatening and must be considered first

- Hypoglycemia
- Hypoxia
- Stroke
- Head Trauma
- Substance Abuse
- Hypothermia
- Hyperthermia


Situational Stress Reactions: Normal reactions to stressful situations produce what emotions?

– Fear
– Grief
– Anger


What should you do when Caring for Patients with Situational Stress Reactions

• Do not rush
• Tell patient you are there to help
• Remain calm
• Keep emotions under control
• Listen to patient
• Be honest
• Stay alert for changes in behavior


Presentations of Behavioral and
Psychiatric Patients?

• Range of presentations
• Withdrawn, not communicating
• Talkative, agitated
• Bizarre or threatening behavior
• Wish to harm selves or others


What are the General Rules for Interactions?

• Identify yourself and role
• Speak slowly and clearly
• Eye contact
• Listen
• Don’t judge
• Open, positive body language
• Don’t enter patient’s space (3 ft)
• Alert for behavior changes


Assessment for the Psychiatric Patient?

• Perform careful scene size-up
• Identify yourself and your role
• Perform primary assessment
• Perform focused physical exam
• Gather thorough history


What are some of the Common Psychiatric Patient Presentations?

• Panic or anxiety
• Unusual appearance (disordered clothing, poor hygiene)
• Agitated or unusual activity
• Unusual speech patterns
• Bizarre behavior or thought patterns
• Self-destructive behavior
• Violence or aggressive behavior


Psychiatric Patient Care?

• Treat life-threatening problems
• Consider medical or traumatic causes
• Follow general rules for positive
• Encourage patient to discuss feelings
• Never play along with hallucinations
• Consider involving family or friends


Facts about Suicide

• Eighth leading cause of death
• Third leading cause in 15–24- year-olds
• Rising numbers in geriatric population

-Suicide Plan
-Stress Levels
-Sudden Improvement
-Recent emotional trauma
-Substance Abuse


Things to explore during a Suicide Patient Assessment

• Explore the following possibilities
– Depression
– High stress levels (current or recent)
– Recent emotional trauma
– Age (15–25 and 40+ highest risk)
– Drug or alcohol abuse
– Threats of suicide
– Suicide plan
– Previous attempts or threats
– Sudden improvement from depression


Suicide Patient Care

• Personal interaction is important
• Do not argue, threaten, or indicate using force
1. Scene safety
2. Identify, treat life-threatening problems
3. Perform history, physical exam
• Detailed exam only if safe
4. Reassess frequently
5. Notify receiving facility


Think about It: Suicide
• Patient is 23-year-old male. His girlfriend called 911 after a domestic dispute. He is uncooperative and refusing treatment. The girlfriend reports patient is depressed and suicidal. He owns a gun and has threatened to shoot himself.

• Can you treat the patient if he did not call?
• Should you believe the girlfriend?
• Does the patient need treatment or transport?
• Can you treat and transport the patient against his will?
• What should you do?


Things to Think about with Aggressive or Hostile Patients

• Consider clues
– Dispatch information
– Information from family or bystanders
– Patient’s stance or position in room
• Ensure escape route
• Do not threaten patient
• Stay alert for weapons of any type


Aggressive or Hostile Patient Assessment

• Ensure safety
• Calm patient
• Perform a thorough assessment
• Restrain patient if necessary


Aggressive or Hostile Patient Care

• Scene size-up
• Request additional help if necessary
• Seek advice from medical control if necessary
• Watch for sudden changes in behavior
• Reassess frequently
• Consider restraint


Reasonable Force and Restraint

• Reasonable force: force necessary to keep patient from injuring self or others
• “Reasonable” determined by
– Patient’s size and strength
– Type of behavior
– Mental status
– Available methods of restraint
• Some systems do not allow restraint without police or medical control orders
• Never attempt restraint without proper legal authority and sufficient assistance


Plan for Restraining a Patient

• Have adequate help
• Plan actions
• Stay beyond patient’s reach until prepared
• Act quickly
• One EMT talks to and calms patient
• Requires four persons, one at each limb
• Restrain all limbs with approved leather restraints in supine position ALWAYS


EMT's Responsibilities for a Restrained a Patient

• EMT is responsible for restrained patient’s airway
• Ensure patient is adequately secured throughout transport
• Apply a surgical mask to spitting patients
• Reassess frequently
• Document thoroughly


What is Excited Delirium

• Extremely agitated or psychotic behavior during struggle, followed by cessation of struggling, respiratory arrest, then death
• Patient is often hyperthermic and shouting incoherently
• Usually preceded by cocaine use
• Often linked to improper restraint in a position where patient cannot expand
chest to breathe adequately (positional asphyxia)
• Be alert for this sequence of events


Transport for a Psychiatric Patient

• Not all hospitals are prepared to treat behavioral emergencies
• Choose correct facility based on
capabilities and local protocol


Medical/Legal Considerations for Psychiatric Patient

• Consent
– Refusals and restraints cause significant medical/legal risk
– Laws typically allow providers to treat and transport patients against their will if a danger to selves or others
– Local protocol may require medical control contact and/or police presence


Medical/Legal Considerations for Psychiatric Patient

• Sexual misconduct
– Behavioral patients, especially those requiring physical contact such as restraint, sometimes accuse EMS providers
– Have same-sex provider attend to patient
– Have third-party witness present at all times, on scene and during transport


Chapter Review Psychiatric Patients

• Ensure your own safety when caring for violent or potentially violent patients.
• Patients with behavioral problems are in crisis and need compassionate care.
• Always consider abnormal behavior to be altered mental status, with a medical or traumatic cause.
• Because treatment of these patients usually requires long-term management, little medical intervention can be done in
the acute situation, but how you interact with them is crucial for their continued well-being.


Remember Psychiatric Patients

• Safety is the first priority when
approaching a patient with altered mental status.
• Psychiatric and behavioral emergencies are prevalent in our society. EMTs should treat them as they would any other potentially life-threatening disorder.
• Assessment of altered mental status should rule out physical causes first.
• Psychiatric and behavioral emergencies can present differently, depending upon
the disorder. There are best practices EMTs employ in approaching, assessing,
and treating such patients.
• Follow local protocols and use appropriate procedures to restrain patients when necessary.


Questions to Consider Psychiatric Patients
• What methods help calm the patient suffering a behavioral or psychiatric emergency?
• What can you do when scene size-up reveals it is too dangerous to approach the
• What factors help assess the patient’s risk for suicide?



Critical Thinking Psychiatric Patients:

• You respond to an intoxicated minor who is physically aggressive, threatens suicide,
and whose parents permit you to treat, but not transport the patient. How would you manage this patient?