5. Clinical Approach to Psychiatric Emergencies

Question 1

There is a large differential diagnosis for altered mental status when presenting to the ER, including hypoxia, sepsis, wernicke encephalopathy, electrolyte abnormalities, hyponatremia, SSRI SE, top two MCC are UTI and ?

Answer 1

Pneumonia

Question 2

Other frequent DOs causing altered behavior include endocrine disorders such as hyper/hypothyroid, MI, strokes, CNS mass lesions, medication SE in elderly, alcohol and medication withdrawal sxs are common and in older adults particularly those with?

Answer 2

dementia are the most vulnerable (with UTI = messy)

Question 3

Work up for altered mental status includes vital signs and oxygen levels, look for neuro deficits, labs including CBC, BMP, UA, glucose, ETOH, drug screen, CT head, CXR and?

Answer 3

EKG

Question 4

*NOTE: if person is acting normal with blood alcohol content of 300, get prepared for withdrawal to be coming soon- v bad

Answer 4

meow

Question 5

Treatment for altered mental status includes focusing on keeping patient and staff safe, along with providing a quiet room and calm conversation. Sedative agents such as lorazepam or what may be given for agitation, it is the MC and safest drug used?

Answer 5

Haloperidol*

Question 6

Lorazepam is helpful, however in older patients do not give them this because it often makes the agitation and confusion worse, what is the other name for the drug?

Answer 6

Ativan** test q

Question 7

Initial treatment for altered mental status include oxygen, abx, glucose and consultants with psych and or?

Answer 7

Neurology

Question 8

When a drunk comes into the ER, H&P is imperative, ask how long pt has been drinking, when was the last drink, history of withdrawal seizures/hallucinations, and previous?

Answer 8

treatments

if yes to withdrawal symptoms-how was it treated?

Question 9

When taking care of a chronic drunk look for elevated blood pressure (diastolic) and or heart rate (if both elevated then can start withdrawal protocol), get CBC- will see what changes regarding MCV and platelets?

Answer 9

High (>100) MCV and low platelets

Question 10

Other labs to order when chronic drunk presents includes BMP to check sodium - hyponatremia is common, check hepatic function, blood alcohol level along with what screening?

Answer 10

Urine drug screening

Question 11

Tx for chornic drunk in ER is IV fluids with thiamine and glucose (thiamine first to prevent wernickes encephalopathy), multivitamins, folic acid, medications for withdrawal include diazepam, chlordiazepoxid for good liver function due to longer half life and smoother, if there is known liver impairment what is MC given?

Answer 11

Lorazepam (Ativan) - MC used drug for withdrawal

Question 12

Violence in health care settings is a growing problem, 50% of health care providers are victims of violence, known psychiatric illness is a risk factor for violent behavior, including dementia, delirium, psychotic depression, mania, personality disorders and?*

Answer 12

schizophrenia (most likely + high on drugs)

Question 13

Initial management of a combative patient is verbal deescalation, call security and physically restrain the patient, give medications like haloperidol, lorazepam, olanzapine, ketamine, and obtain hx such as previous episode, family history and history of?

Answer 13

drug and alcohol use

Question 14

Labs to asses when someone comes into the ER includes ***urine drug screen, CBC, CMP, CT of head, and consults with psychiatry, neurology and?

Answer 14

Internal medicine

Question 15

Suicidal patient is brought to ER, you should be calm, nonthreatening, and **Nonjudgmental, evaluate for risk and protective factors, and if risks outweigh protective then?

Answer 15

Admit the patient to the hospital

Question 16

Risk factors for suicidal patients include previous attemps, psych dxs, substance abuse, lack of support, medical condition, burden to family, impulsive tendencies, cultural or religious beliefs, local epidemics of suicide isolation, a main reason why suicide is so prevelant is due to barriers to?

Answer 16

accessing mental health treatment

Question 17

Protective factors for a suicidal patient include effective clinical care for mental and substance abuse DOs, easy access to clinical interventions, family support, young children, support from health care relationships, skills in problem solving, and cultural and religious beliefs that?

Answer 17

discourage suicide and instincts for self preservation

Question 18

A suicidal patient should be admitted to inpatient psychiatric unit when risk factors outweight protective factors, when there are affidavits of patients suicide attempt (involuntary commitment), known dx of psychiatric illness or when you have?

Answer 18

a gut feeling**