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NMSK Exam 1 > 5. Psychiatric MRGNCIEs > Flashcards

5. Psychiatric MRGNCIEs Flashcards

1
Q

What are the most common types of psychiatric MRGNCIES?

A

1. Panic Disorder

2. Suicide

3. Intoxication

4. Psychosis

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2
Q

Diagnostic approach to an adult with AMS.

A
  1. Decreased level of consciousness?
    1. Yes => coma or stupor
    2. No => acute neurological defect? (hemiparesis, aphasia, visual field loss)
      1. Yes => stroke or mass lesion
      2. No => ABNL mental status testing or abnormal ATN span?
        1. Yes => confusion/delrium
        2. No => thought/psychiatric disorder
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3
Q

What common conditions can cause AMS/confusion?

A
  1. UTI
  2. Pneumonia
  3. Eletrolyte imbalance (hyponatremia)
  4. Medications and alcohol: AE/interactions/withdrawal
  5. Psychiatric illness
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4
Q

Other frequent disorder that can cause altered behavior/confusion?

A
  1. Endocrine disorders (thyroid disease)
  2. MI
  3. Strokes w/o motor deficits
  4. CNS mass lesions
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5
Q

Who is most vulnerable to altered mental status?

A
  1. Older adults, particularly those with dementia
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6
Q

W/U of patient with AMS

  • Labs?
  • Radiology?
  • OTher
A
  1. Vitals: O2 levels
  2. PE: look for neuro deficits
  3. Labs: CBC/CMP, UA, Glucose finger stick, ETOH and drug screen
  4. Radiology: CT of head and CXR
  5. EKG
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7
Q

Pt comes in with confusion: 1st thing you do is?

A
  1. Check glucose and O2.
  • No = correct
  • Adequate => look for fever or other signs of infection
    • Yes => look for source and treat
    • No => Conduct H&P to suggest altered behavior?
      • Yes => pursue cause
      • No => labs
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8
Q

How should we treat a patient with AMS?

A
  1. Focus on keeping the patient and staff safe
  2. Environmental manipulation: put in a quiet room and talk calmly
  3. Sedate pt if needed
  4. Start treating based in intitial test results: O2, ABX, glucose or consult
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9
Q

What should we gie a patient with AMS who is agitated to protect pt and staff?

A
  • Haloperidol or lorazepam
    • Haloperidol 2-5 mg IM q 15-30 minutes until agitation is controled
    • In older patients, lorazepam makes agitation and confusion WORSE.
  • Alt: Olanzapine 2.5 - 5mg IM q/3 hours.
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10
Q

If a pt comes into the ED intoxicated and begins to go under alcohol withdrawal, what is the INITIAL management?

A
  1. H & P
    1. How long has pt been drinking and when was the last drink?
    2. Hx of withdrawal seizures/hallucinations?
    3. Previous Tx?
  2. Vitals: look for high BP, HR
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11
Q

If a pt comes into the ED intoxicated and begins to go under alcohol withdrawal, what labs should we conduct?

A
  1. CBC/BMP (look at MCV, platelets and hyponatremic)
  2. Liver function
  3. Blood alcohol level
  4. Urine drug screen
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12
Q

What IV fluids should you give a patient who comes in intoxicated and starting to withdraw?

A
  1. First => thiamine => glucose to prevent Wernicke’s encephalopthy
  2. Multivitamins
  3. Folic acid
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13
Q

What medications for withdrawal should you give a patient who comes in intoxicated and starting to withdraw?

A
  1. Chlodiazepoxide, if good liver.
  2. Lorazepam, if patient has liver damage
  3. Diazepam
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14
Q

What is a risk factor violence in the ER?

A
  • Known PSYCHIATRIC ILLNESS
      1. Schizo (paranoid and non-aranoid)
      1. Personality disorders
      1. Mania
      1. Psychotic depression
      1. Hx of incarceration due to violence
      1. Delerium/dementia
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15
Q

Initial management of a violent patient in the ED

A
  1. KEEP STAFF AND PT SAFE:
    1. verbally de-escalate, call security and restrain, meds
  2. Get more hx:
    1. Previous episodes
    2. FHx
    3. Drug and ETOH use
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16
Q

Violent Patient

  1. Labs
  2. Radiology
  3. Consults
A
  1. Labs: urine drug screen, CBC/BMP
  2. Radiology: CT of head
  3. Consults: Internal med, psych and neuro
17
Q

When evaluating a patient who is suicidal, you should be: _______

A

calm, non-threatening, non-judgmental

18
Q

When should you admit a suicidal patient?

A
  1. When risk factors > protective factors
  2. Document of patients suicide attempt (involuntary commitment)
  3. Known diagnosis of a psych illness
  4. Go with GUT!
19
Q

How to eval a suicidal patient?

A
  1. Eval risk factors
  2. BArriers to accessing mental health treatment?
  3. PRotective factors?

NMSK Exam 1 (22 decks)

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