Acute psychiatric emergencies

Question 1

Confidently approach psychiatric emergencies with a range of pharmacologic and non-pharmacologic tools.

Answer 1

AED then 3 C’s
Assess
Engage
De-escalate

Calm
Caring
Clear choices

Question 2

Use these tools in a safe, effective, and unambiguous fashion.

Answer 2

Psychiatric emergencies are common
Goal is to help patient re-establish control
Safety is always first
If cooperative use de-escalation treatments
Preserve patient choice if possible
Select medications based on common causes
Select PO and lowest dose if possible

Question 3

Non-pharmacologic principles and approaches to managing agitated and potentially violent patients

Answer 3

Respect personal space  assess physical space; stay between the door and the patient; arms open; be narrow and in front of the pt; stay 2-3 leg-lengths away from pt. DO NOT TOUCH
Identify actions, words that are escalating (NOT de-escalating)  repetitive movements/phrases
Do not be provocative  in body language & verbal language
Establish verbal contact = introduce yourself and address pt by name.
Be Concise
Identify wants and feelings = “I want you to go as soon as you’re able”
Listen closely to what the patient is saying
Agree or agree to disagree
Lay down the law and set clear limits = “safety & effective clinical care”  scaring the staff
Offer choices and optimism = even if same end-point happens
Debrief the patient and the staff