Adult - Disruptive Behaviour

Question 1

Adult Psychiatric - Disruptive Behavior - Key features of excited delirium syndrome? (8)

Answer 1

Drug abuse Hx
Psych Hx
Inappropriate removal of clothing
Violent/bizarre behavior
Insensitivity to pain
Unexpected strength or endurance
Constant activity
Shouting/unintelligible noises

Question 2

Adult Psychiatric - Disruptive Behavior - disruptive patients >65 yo?

Answer 2

Consider medical causes

Haloperidol 2.5 mg IM no repeat

Question 3

Adult Psychiatric - Disruptive Behavior - Disruptive patients <65 yo?

Answer 3

Consider medical causes
Midazolam 5 mg IV, 10 mg IM total max of 20 mg
Haloperidol 5 mg IM if midazolam not effect

Question 4

Adult Psychiatric - Disruptive Behavior - Treatment for dystonic reaction from haloperidol?

Answer 4

Diphenhydramine 1 mg/kg max of 50 mg

Question 5

Adult Psychiatric - Disruptive Behavior - Medical causes for combative behavior? (6)

Answer 5

Head injury
Hypoxia
Acidosis
Infection
Seizures
Stroke/SAH

Question 6

Adult Psychiatric - Disruptive Behavior - Minimum monitoring of pt’s who have received benzodiazepines should include?

Answer 6

SpO2
EtCO2
4-lead ECG

Question 7

Adult Psychiatric - Disruptive Behavior - midazolam dose?

Answer 7

5 mg IV or 10 mg IM - Max of 20 mg

Question 8

Adult Psychiatric - Disruptive Behavior - midazolam indications?

Answer 8

Control of disruptive behaviour

Question 9

Adult Psychiatric - Disruptive Behavior - midazolam contraindications?

Answer 9

Hypersensitivity
Myasthenia gravis
BP < 100 mmHg

Question 10

Adult Psychiatric - Disruptive Behavior - midazolam may cause?

Answer 10

Respiratory depression

Hypotension

Question 11

Adult Psychiatric - Disruptive Behavior - haloperidol indications?

Answer 11

disruptive behaviour unresponsive to 20 mg midazolam
or
Disruptive patients >65

Question 12

Adult Psychiatric - Disruptive Behavior - haloperidol dose?

Answer 12

<65 - 5 mg IM

>65 - 2.5 mg IM

Question 13

Adult Psychiatric - Disruptive Behavior - haloperidol contraindications?

Answer 13

Hypersensitivity
CNS depression
Spastic disease
Parkinson’s syndrome
Seizure history

Question 14

Adult Psychiatric - Disruptive Behavior - haloperidol can cause?

Answer 14

QT prolongation

Question 15

Adult Psychiatric - Disruptive Behavior - diphenhydrAMINE indications?

Answer 15

Dystonic reaction to haloperidol

Question 16

Adult Psychiatric - Disruptive Behavior - diphenhydrAMINE dose?

Answer 16

1 mg/kg IM/SIVP/PO to max of 50 mg

Question 17

Adult Psychiatric - Disruptive Behavior - diphenhydrAMINE contraindications?

Answer 17

Hypersensitivity to diphenhydrAMINE or dimenhyDRINATE

Question 18

Adult Psychiatric - Disruptive Behavior - diphenhydrAMINE precautions?

Answer 18

IM in the lateral quad

Avoid in nursing mothers and neonates

Question 19

Adult psychiatric - Disruptive Behavior - Haloperidol is given by which route?

Answer 19

IM only