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36 Cards in this Set

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Identify the sequence of questions that will help you develop a decision strategy for psychiatric assessment of a patient with behavior disorders
Is pt stable/unstable? Does pt have serious med condition causing behavior? If not result underlying med cond, is it psychiatric or functional? What is dx & severity? Is psych consult necessary? When should pt be forcibly detained for emergency evaluation?
Discuss your approach and possible use of physical restraints with the following: Violent behavior
demands immediate restraint. Hospital security forces and police are best equipped and trained to subdue violent pts with least chance of staff or patient injury
PSYCH EM
PSYCH EM
When should a pt be restained
Patients displaying violent behavior or threatening violent behavior
How would you approach patients displaying violent behavior or threatening violent behavior
restrain, remove potential weapons like belts etc., approached cautiously with nonthreatening attitude & adequate security nearby,
How do you approach the patient expressing suicidal ideation
remove dangerous objects, supervision, not allowed to leave ED before medical or psychiatric evaluation
How should you approach Restraint and Seclusion of a pt
limit use of restraints or seclusion to situations where less restrictive interventions have failed and clinical appropriateness is clearly justified
Define restraint
any device including manual holds that is attached or adjacent to pt's body that cannot be removed easily and restricts freedom of movement or normal access to one's body
Define seclusion
involuntary confinement of a person in a room or area so that the person is physically prevented from leaving
Who can order restraints
only licensed independent practitioners (LIPs) can order. However often LIP is not present when need is determined. Trained caregivers may institute restraint but LIP must perform face-to-face eval within 1 h of restraint use
What are the restriction or time limits when using restraints
1 h for children younger than age 9, 2 h for individuals aged 9 to 17 years, and 4 h for individuals aged 18 and older.
How often should a pt be evaluated while in restraints or seclusion
continuous monitoring is required. Those in restraints require evaluation every 15 min to check for signs of injury
Are soft restraints Kosher for the truly violent pt
Soft restraints should never be used on a truly violent patient
What's the rule about handcuffs
if pt is brought to ED in handcuffs, they should remain in handcuffs until threat of violence and medical condition are assessed
Identify possible life-threatening medical conditions that may present as a psychiatric disorder
meds, drugs, etoh, hypoglyc., CNS, psychosocial, cardiac
Discuss the incidence of domestic violence to women
5 million visits yr to ED do to IPVA. 4-15% women seen because of sx related to IPVA, with 2-4% presenting acute IPVA. 50%+ of women seen in EDs have experienced IPVA some time in their lives
What you can do to help the battered patient
recognize, validate, assess, refer, document
Identify the two classes of drugs that are the most useful in the emergency setting when managing psychiatric behavior disorders
Antipsychotic and anxiolytic
List the behavioral features that are targeted for rapid tranquilization of a patient.
Used to control agitated or psychotic behavior that constitutes and imminent danger to the pt or others
Identify the class of drugs preferred for the treatment of agitation due to cocaine intoxictaion or alcohol withdrawal.
Anxiolytics such as benzodiazepines or lorazepam
List the three predictors of violence when evaluating a patient
Past hx of violent behavior, organic or functional cause
Identify two diseases that are most likely involved in a patient with violent behavior
hypoglycemia, drug / alcohol abuse or withdrawal.
List five ancillary tests that should be considered in the evaluation of the violent patient and what you are looking for with each of them.
labs, toxicology screening, electrocardiograms, CT and LP
List the three phases in the prodrome of violence,
anxiety, defensiveness, physical agression
Be familiar with the indications and guidelines in the use of physical restraints.
When pt has potential to harm themselves or others or who will compromise their medical care
Know what needs to be reflected in the medical chart when physically restraining a violent patient.
Written order with type restraint, reason, time limit. Limit 1h for children <9. 2H ages 9-17, 4h for 18+. Must have continuous monitoring, require eval every 15 minutes
Describe the single best way to handle a violent patient or curtail potential violence in the ED
Recognizing prodromes of violence and phases of escalation and dealing with each one appropriately
Describe important components of the mental status examination that should be utilized in the emergency department
distinguish functional from organic disorders. components include LOC, spontaneous speech, behavioral observation, physical appearance, relaying info, attention, language comp
Give examples of how these components can be assessed.
ask: PPTE, recent memory (name 3 object 5 min. later) remote mem (hx ?'s) mental calculation, focal neurologic deficits
Idnetify risk factor catagories for suicide
marital status, job status, relationships, fam hx, health - physical, mental, suicidal ideations / attempts,
Discuss the use of drug overdose as a means of attempting suicide.
majority of all contemporary suicide attempts, tend to parallel prevailing rx patterns,
Discuss the relative risk of violent means for attempting suicide
considered serious and a high-risk factor for future attempts
Explain what is meant by "secondary gain" as related to suicide attempts
attempt to meet another need other than death such as attention, or plea for emotional help.
Describe the typical adolescent who commits suicide
hx of substance abuse, disruptive disorders, anxiety, mood disorder, schizophrenia, gender ID concerns
Explain how to use a "no harm contract"
verbal or written agreement in which suicidal pt is asked to agree not to harm or kill themself for a period of time.
describe the general rule in determining suicide risk as it pertains to men and women
men are 2-3x's more likely to complete suicide where women are 2-3x's more likely to attempt suicide