Acute Behavioural Disturbances

Question 1

Four general categories of ABD

Answer 1

Psychiatric
Substance related
Organic/clinical causes
Situational

Question 2

Examples of psychiatric causes of ABD

Answer 2

Schizophrenia
Bipolar disorders
PTSD
Psychosis

Question 3

Examples of organic/clinical causes of ABD

Answer 3

Hypoglycaemia
Sepsis
Hypoxia
Head injury
Drug withdrawal
Dementia
Post-ictal
Head injury

Question 4

What are the main AT principles of ABD management?

Answer 4

SAFETY
- Safety of scene and self/patient
- Aggression
- Fix organic causes
- Evaluate the patient (VSS, etc)
- Tactical communication (active listening, empathy, rapport)
- Yes, I have the right resources

Question 5

De-escalation Strategies

Answer 5

1. Approach the situation with the right attitude and maintain your self-control
2. Ensure non-aggressive communication with voice and body language
3. Match energy levels – respond appropriately and use the a “voice-for-the-occasion”
4. Empathise and actively listen
   Help the patient focus on the issue at hand and the immediate solution

Question 6

What are the several phases of the AT ABD guidelines?

Answer 6

1. Danger/SAT assessment
2. Communication: deescalation
3. Consider reversible causes
4. Restraint/sedation

Question 7

Sedation Assessment Tool (SAT)

Answer 7

Simple, rapid used to determine the measure of the degree of agitation or sedation of patients with ABD.

Question 8

SAT Classifications

Answer 8

+3: Combative, violent, out of control; Continual loud outbursts
+2: Very anxious and agitated; Loud outbursts
+1: Anxious/restless; Normal/talkative
0: Awake and calm/cooperative; Speaks normally
-1: Asleep but rouses if name is called; Slurring or prominent slowing
-2: Responds to physical stimulation; Few words
-3: No response to stimulation; Nil speech

Question 9

When to administer sedation

Answer 9

SAT +2 or +3

Question 10

Mental Health Act/Protective custody: Paramedics may take a patient into protective custody if:

Answer 10

• Patient is a danger to themselves or others; and
• The person has a mental illness; and
  The person requires examination against the assessment order by a physician

Question 11

AT management: SAT +1 (mildly aroused)

Answer 11

e.g. Pacing, anxious, agitated
* De-escalation strategies
* Diazepam 10mg (>60YO 5mg) repeated after 60 mins PRN (max. 40mg)

Question 12

AT management: SAT +2 +3 (Highly aroused with physical threat imminent)

Answer 12

• No IV access: IM Droperidol 10mg (>60yo or <50kg = 5mg). Repeated after 15mins if SAT remains high.
• IV Access: IV Droperidol 5mg. Repeated after 10mins PRN.
• If SAT remains high, ICP back up for midazolam/ketamine.