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Emergency Medicine > Psychiatric Emergencies > Flashcards

Psychiatric Emergencies Flashcards

1
Q

acute changes in behavior that negatively impact a patient’s ability to function in his or her environment

A

Psychiatric emergencies

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2
Q

screening assessment - For psychiatric emergencies, perform an effective ______, probing for ______ and completing a ________

A
  • screening assessment
  • organic causes
  • psychiatric safety check
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3
Q

difference between screening assessment vs psychiatric safety check?

A
  • Screening: r/o underlying medical cause
  • Psychiatric safety check: looks for suicidal ideation, homicidal ideation, or pts’ inability to care for themselves
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4
Q

what type of pt would disposition them to not leave the ED prior to medical and psychiatric exam?

A

agitated/distressed pts
suicidal/homicidal

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5
Q

what type of hallucinations are more suggestive of a medical cause vs a psychiatric cause?

A
  • Visual hallucinations = medical etiology
  • auditory hallucinations = psychiatric etiology
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6
Q

PE of a psychiatric emergency involves what?

A
  • disrobed, gowned, and searched
  • Thorough PE + neuro assessment
  • Look for physical clues to source of an AMS - head injury, drugs, infection or toxidromes.
  • Assess for adverse consequences of behavior - malnutrition, mutilation or dehydration.
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7
Q

red flag signs of medical dysfunction?

A
  • lability of affect
  • simple questions need repeated
  • irritability
  • disorientation
  • uncooperative
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8
Q

when would a urine/serum drug screen and BAC not be warranted when evaluating a pt?

psych emergencies

A

if pt is awake, alert and cooperative

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9
Q

Early warning signs of impending violence:

A
  1. threatening statements
  2. loud voice
  3. agitated movements
  4. shifting body positions toward a fighting posture
  5. clenched fists
  6. striking inanimate objects
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10
Q

what is the S.A.F.E.S.T. Approach?

A
  • Spacing
  • Appearance
  • Focus
  • Exchange
  • Stabilization
  • Treatment
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11
Q

Spacing when you are dealing with a violent pt?

A
  • Maintain distance - 2 arm’s length
  • Do not touch
  • equal access to the door
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12
Q

how is the appearance when managing a violent pt?

A
  • empathetic professional detachment.
  • Use one primary contact person
  • Have security staff available
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13
Q

what are you focusing on when managing a violent pt?

A
  • Watch pt’s hands
  • Look for potential weapons and escalating agitation
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14
Q

how should the Exchange be when managing a violent pt?

A
  • Calm, continuous talking - crucial to verbal de-escalation
  • Avoid punitive or judgmental statements.
  • Use good listening skills.
  • discuss current problem to develop a non-life-threatening resolution and to elicit pt’s cooperation with tx.
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15
Q

methods to stabilize when managing a violent pt?

A

physical restraints, sedation or chemical restraints - Attempt compliant sedation first

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16
Q

medication for sedation?

A

lorazepam (Ativan) 1–2 mg IM/IV

Dosing may be repeated to achieve effect while monitoring for side effects including respiratory depression

17
Q

when are physical restraint needed?

A

Used only when pt poses immediate threat to self or others and is obstructing evaluation or tx

18
Q

when is chemical restraint used?
what is used?

A
  • for patients not responding to sedation
  • Neuroleptics, such as haloperidol (Haldol) 5 mg IM q 30 mins until pt is in more control
19
Q

SE of haloperidol

A

Monitor frequently for extrapyramidal sx and QT prolongation

20
Q

The best screening approach to recognize suicidal ideation involves ?

A

general questions about the pt’s emotional state.

“What are your feelings about living and dying?”
“What has stopped you from killing yourself so far?” (protective factors)

21
Q

high risk factors for suicide?
scoring?

A
  • S - sex - males
  • A - age - middle age (45-64 years)
  • D - depression
  • P - previous attempt
  • E - ethanol use
  • R - rational thinking loss
  • S - social support lacking
  • O - organized plan
  • N - no spouse
  • S - sickness

≥5 points = high risk of suicide

22
Q

Pt indicates remorse, shame, or embarrassment at suicide attempt

would this be a low or high risk for suicidial attempt?

A

low risk

23
Q

Pt sits quietly; engages poorly with physician; voices regret at surviving; expresses feelings of hopelessness, helplessness, or exhaustion, refuses to provide additional information

would this be a low or high risk for suicidial attempt?

A

high risk

24
Q

approach after an involuntary admission of a suicidal patient?

A

follow hospital protocol

  1. Contact magistrate or social services
  2. Mental hygiene commissioner must perform an eval (via telephone or in person) in order to determine if there are grounds for issuing an involuntary hold
  3. involuntary hold in ED until hearing can be scheduled (24 hrs or next business day)
  4. ED provider filing mental hygiene warrant may have to testify at the hearing
25
Q

disposition for high risk suicidal pt

A
  1. voluntary vs involuntary admission
  2. one-on-one suicide prevention
26
Q

mgmt for moderate risk suicidal pt?

A
  • consult psychiatry to discuss disposition
  • Responds well to initial intervention and have good social support
  • +/- outpatient therapy
27
Q

when can a moderate suicidal risk pt attempt outpatient therapy?

A
  1. No medical intervention is needed
  2. Establish therapy w/ close f/u (psych, counselor and PCP) - 2 wks of meds
  3. Develop a safety plan
    - Remove all means of suicide (firearms, drug supplies)
    - Family manages pt medications
28
Q

patients who present with suicidal ideation, threats, plans, or minor attempts which occur in a definable external crisis
Great family/social support is present

what is the severity of suicidal risk is this pt

A

low risk

29
Q

criteria for DC for low suicidal risk pt?

A
  1. medical treatment isn’t needed
  2. no previous suicide attempt
  3. not actively suicidal
  4. reliable adult in home in which pt has a good relationship with who agrees to monitor pt - remove all means of suicide (guns/medications)
  5. Info on return precautions if pt worsens
  6. F/u PCP or psychiatry arranged
30
Q

a verbal or written agreement initiated by the provider in which the suicidal patient agrees not to harm or kill themselves

A

“No-Harm/Suicide Prevention” Contracts

31
Q

components of “No-Harm/Suicide Prevention” Contracts

A
  • Family member who will assume responsibility of patient
  • Actions family and patient will take to reduce risk of suicide
  • Agreed-upon help-seeking behaviors if a crisis arises
32
Q

T/F: “No-Harm/Suicide Prevention” Contracts have MC shown that they prevent suicidal behavior

A

F - No evidence supports that developing this contract prevents suicidal behavior

33
Q

an agreement to treatment and proper follow up

A

Joint Safety Plan

34
Q

disposition of a homicidal pt?

A
  1. Immediate hospitalization and psychiatric consultation is mandatory
  2. Should be closely monitored by security personnel
35
Q

disposition of psychiatric emergency is based upon on the presence of ? (4)

A
  • danger to self or others
  • the ability to care for oneself
  • the desire and ability to cooperate with tx
  • available support systems should also be considered
36
Q

what is Involuntary commitment?

A

legal process by which a person is confined in a psychiatric hospital because of a treatable mental disorder, against his or her wishes.

Emergency Medicine (20 decks)

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