abnormal behaviour

Question 1

hx of organic cause in a patient P/W abnormal behaviour

Answer 1

acuity of onset 
psych illness hx 
extreme of age
Drug and alcohol use 
symptoms of infection

Question 2

List organic cause examination findings in a patient P/W abnormal behaviour

Answer 2

abnormal vital signs
neurological deficit on examination
skin rash suggesting infection
Signs of head injury

Question 3

non pharmacological ways to control abnormal behaviour in ED

Answer 3

Verbal de escalation 
low stimulus environment 
separate place 
Engage parents ( if minor ) 
show of force/security presence 
offer foods

Question 4

Pharmacological ways to control abn behavi

Answer 4

1-IM Midazolam 10 mg , rpt 15 min , max 20-40 mg/24hr
2- IM Droperidol 10mg , rpt 10 -20min, max 20 mg/24hr
3-IM Ketamine 4mg/kg
4- IM lorazepam 2 mg , rpt 30 min ,max 6 mg/24hr

Question 5

List 4 assessment issues need to be addressed in a patient P/W abnormal /bizzar behaviour ( patient is refusing to be assessed in ED )

Answer 5

1-capacity of patient to refuse treatment
2-assess in dedicated secure area
3- presence of mental health team /security
4- organic causes of this behaviour ( intoxication )

Question 6

Organic cause mimics

Answer 6

1- infection : encephalitis 
2- metabolic : thyrotoxicosis 
3-trauma : head injury 
4- neurological : post seizure 
5- toxic : drugs and alcohol intoxication

Question 7

Features of delirium

Answer 7

1- acute onset 
2- fluctuating course 
3- inattention 
4-Disorganised behaviour
5- concurrent medical illness .

Question 8

Aggression management( escalating mx )

Answer 8

1- verbal de escalation
2- show of force , with security of hospital presence 
3- Offer  oral sedation 
4- parenteral sedatives if above fails 
5- physical restrain if above fails

Question 9

Causes of abnormal behaviour , agitation at home where the patient physically attacked his father when he tried to calm him down , DD categories for this presentation ?

Answer 9

1- organic : acute intoxication ( serotonin syndrome, ETOH ) , infection , head trauma , metabolic( hypoglycemia ) , neurological ( post ictal )
2- acute mental illness eg psychosis

Question 10

Complications of emergency sedation

Answer 10

1- resp depression
2-CVS depression : arrhythmia , QT prolongation
3-hypotension
4- allergy

Question 11

departmental design to mitigate aggression

Answer 11

1-seperate assessment and waiting areas
2-low stimulus areas
3- two separate entrance/exit
4-Duress alarms

Question 12

system wide approach to mitigate aggression

Answer 12

1- Hospital wide alert system
2- zero tolerance policy for aggression towards staff
3- Adequate pre hospital notification
4- Trained staff available to mitigate aggression
5- Separate psychiatric triage area