Behavioral & Psychiatric Emergencies & Suicide Flashcards

1
Q

Introduction: Patients may present with unexpected or dangerous behavior which may result from?

A

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

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2
Q

What Is a Behavioral Emergency?

A

• 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

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3
Q

Psychiatric Causes of Behavioral Emergencies

A
• Psychiatric condition (mental disorder)
– Anxiety or panic disorder
– Depression
– Bipolar disorder
– Schizophrenia
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4
Q

Non-psychiatric causes of altered

mental status can be life-threatening and must be considered first

A
  • Hypoglycemia
  • Hypoxia
  • Stroke
  • Head Trauma
  • Substance Abuse
  • Hypothermia
  • Hyperthermia
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5
Q

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

A

– Fear
– Grief
– Anger

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6
Q

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

A
  • 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
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7
Q

Presentations of Behavioral and

Psychiatric Patients?

A
  • Range of presentations
  • Withdrawn, not communicating
  • Talkative, agitated
  • Bizarre or threatening behavior
  • Wish to harm selves or others
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8
Q

What are the General Rules for Interactions?

A
  • 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
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9
Q

Assessment for the Psychiatric Patient?

A
  • Perform careful scene size-up
  • Identify yourself and your role
  • Perform primary assessment
  • Perform focused physical exam
  • Gather thorough history
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10
Q

What are some of the Common Psychiatric Patient Presentations?

A
  • 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
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11
Q

Psychiatric Patient Care?

A
• Treat life-threatening problems
• Consider medical or traumatic causes
• Follow general rules for positive
interactions
• Encourage patient to discuss feelings
• Never play along with hallucinations
• Consider involving family or friends
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12
Q

Facts about Suicide

A
  • Eighth leading cause of death
  • Third leading cause in 15–24- year-olds
  • Rising numbers in geriatric population
  • Depression
  • Age
  • Suicide Plan
  • Stress Levels
  • Sudden Improvement
  • Recent emotional trauma
  • Substance Abuse
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13
Q

Things to explore during a Suicide Patient Assessment

A
• 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
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14
Q

Suicide Patient Care

A
• 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
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15
Q

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.

A
  • 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?
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16
Q

Things to Think about with Aggressive or Hostile Patients

A
• 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
17
Q

Aggressive or Hostile Patient Assessment

A
  • Ensure safety
  • Calm patient
  • Perform a thorough assessment
  • Restrain patient if necessary
18
Q

Aggressive or Hostile Patient Care

A
  • 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
19
Q

Reasonable Force and Restraint

A

• 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

20
Q

Plan for Restraining a Patient

A
  • 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
21
Q

EMT’s Responsibilities for a Restrained a Patient

A
  • 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
22
Q

What is Excited Delirium

A

• 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

23
Q

Transport for a Psychiatric Patient

A

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

24
Q

Medical/Legal Considerations for Psychiatric Patient

A

• 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

25
Q

Medical/Legal Considerations for Psychiatric Patient

A

• 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

26
Q

Chapter Review Psychiatric Patients

A

• 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.

27
Q

Remember Psychiatric Patients

A

• 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.

28
Q

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
patient?
• What factors help assess the patient’s risk for suicide?

A

.

29
Q

Critical Thinking Psychiatric Patients:

A

• 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?