Behavioral Health Emergencies Flashcards
Although you cannot determine what has caused a person’s crisis, you may be able to predict whether a person will become ___
Violent
What you can see of a person’s response to the environment
Behavior
Stress is managed by the use of ___
Coping mechanisms
Describes the situation involving patients of all ages who exhibit agitated, violent, or uncooperative behavior or who are a danger to themselves or others
Behavioral crisis
The basic activities a person usually accomplishes during a normal day, such as eating, dressing, and bathing
Activities of daily living
A persistent feeling of sadness and despair
Chronic depression
Depression may be a symptom of an underlying ___
Health disorder
When a behavioral health emergency arises, patients may show ___
Agitation or violence or become a threat to themselves or others
A behavioral health emergency is more serious than a typical ___ that causes inappropriate behavior
Behavioral crisis
When there is an immediate threat to the person involved or when a patient’s behavior threatens you, family, friends, or bystanders, the situation should be considered a ___
Behavioral health emergency
An illness with psychological or behavioral symptoms that may result in impaired functioning
Psychiatric disorder
Most common mental health disorders
Anxiety disorder
Includes generalized anxiety disorder, panic disorder, and social and other phobias
Anxiety disorder
Has specialized training dealing with more complex psychological conditions
Pyschologist
For the treatment of the most severe conditions, such as schizophrenia or bipolar disorder, a ___ may need to prescribe medication
Psychiatrist
Two basic categories of diagnosis that a physician will use for a behavioral crisis or emergency
- Organic (physical)
- Functional (psychological)
Temporary or permanent dysfunction of the brain caused by a disturbance in the physical or physiological functioning of brain tissue
Organic brain syndrome
Causes of organic brain syndrome include ___
- Sudden illness
- Traumatic brain injury
- Seizure disorders
- Drug and alcohol abuse
- Overdose
- Withdrawal
- Diseases of the brain, such as Alzheimer dementia or meningitis
Altered mental status can arise from a physiological issue such as ___
- Hypoglycemia
- Hypoxia
- Impaired cerebral blood flow
- Hyperthermia
- Hypothermia
In the absence of a physiologic cause, altered mental status may be an indicator of ___
A psychiatric disorder such as bipolar disorder
A physiologic disorder that impairs bodily function when the body seems to be structurally normal
Functional disorder
Schizophrenia, anxiety conditions, and depression are good examples of ___ disorders
Functional
A disorder where something has gone wrong, but the root cause cannot be identified
Functional disorder
The chemical or physical basis of these disorders does not alter the appearance of the patient
Functional disorder
A patient displaying bizarre behavior may actually have ___ that is the cause, or partial cause, of the behavior
Acute medical illness
Safety guidelines for a behavioral health emergency
- Assess the scene
- Ensure you have a means of communication, such as a radio
- Know where the exits are
- Don appropriate PPE
- Have a definite plan of action
- Urgently deescalate the patient’s level of agitation
- Calmly identify yourself
- Be direct
- Be prepared to spend extra time
- Stay with the patient
- Do not get too close to a potentially volatile patient
- Express interest in the patient’s story
- Avoid fighting with the patient
- Be honest and reassuring
- Do not judge
When working with a potentially volatile patient, position yourself at at ___ angle
45°
Begin your assessment from the ___
Doorway or from a distance
Engage family members or loved ones to encourage the patient’s ___
Cooperation
Unless your patient is unstable from a ___, prepare to spend time with your patient
Medical problem or trauma
Four major areas as possible contributors to the patient’s behavioral crisis or emergency to consider during history taking
- Is the patient’s CNS functioning properly?
- Are hallucinogens or other drugs or alcohol a factor?
- Are significant life changes, symptoms, or illness (caused by mental rather than physical factors) involved
- If a patient has a history of behavioral health illness, has there been a recent change in medications?
Specific questions to ask during the SAMPLE history to pass to the hospital staff
Previous episodes, treatments, hospitalizations, and medications related to behavioral symptoms
In geriatric patients, consider ___ as possible causes of abnormal behavior
Alzheimer disease and other causes of dementia
History taking assessment has two primary goals
- Recognizing major threats to life
- Reducing the stress of the situation as much as possible
A technique used frequently by mental health professionals to gain insight into a patient’s thinking
Reflective listening
Involves repeating in question form, what the patient has said, encouraging the patient to expand on his or her thoughts
Reflective listening
Obtain vital signs only if you are able to do so without worsening your patient’s ___
Emotional condition
A patient who has a blank gaze or rapidly moving eyes may be experiencing ___
CNS dysfunction
In many patients with autism, making eye contact can ___
Be very stressful and may cause the patient to become agitated
If you feel transport may put you at risk, ___
Ask LE personnel to accompany you
If a police officer restrains the patient with handcuffs, the officer must ___
Ride in the back of the ambulance to release the cuffs in case of an emergency
Placing the stretcher in the ___ position helps prevent aspiration and reduces physical exertion by relaxing the abdominal muscles
Fowler or high Fowler
If restraints are necessary, reassess the patient’s ___ every ___
- Respirations, pulse, motor and sensory functions in all restrained extremities
- 5 minutes
If the patient is spitting ___
Place a surgical mask loosely over their mouth and wear appropriate PPE
State of delusion in which the person is out of touch with reality
Psychosis
Common causes of psychosis
- Mind-altering substances
- Intense stress
- Delusional disorders
- Schizophrenia
A complex disorder that is not easily defined or easily treated. It affects how a person thinks, feels, and behaves
Schizophrenia
Schizophrenia’s onset typically occurs during ___
Early adulthood, between the ages of 16 and 30 years
Symptoms of schizophrenia
- Delusions
- Hallucinations
- Paranoia
- Lack of interest in pleasure
- Erratic speech
Guidelines for dealing with a psychotic patient
- Determine the danger
- Clearly ID yourself
- Be calm, direct, and straightforward
- Maintain an emotional distance
- Do not argue or go along with delusions
- Explain what you would like to do
- Involve people the patient trusts
A condition of impairment in cognitive function that can present with disorientation, hallucinations, or delusions
Delirium
A behavior characterized by restless and irregular physical activity
Agitation
Also known as agitated delirium or exhaustive mania
Excited delirium
Common physical symptoms of excited delirium
- Hypertension
- Hyperthermia
- Tachycardia
- Diaphoresis
- Dilated pupils
Physical agitation can lead to sudden death, thought to result from ___
Metabolic acidosis
Occurs when a patient’s physical position restricts chest wall movements or causes airway obstruction
Positional asphyxia
Protocols should include only the use of restraint devices that have been ___
Approved by the state health department or local EMS agency
EMS protocols should avoid the use of ___ restraints if possible
Hard
The method of restraint chosen should be the ___
Least restrictive method that will ensure the safety of the patient and providers
Ideally ___ people should be present to carry out the restraint
5
Position to restrain a physically uncooperative patient
Supine, with one arm up and one down, the head elevated at a 30° angle
Physical restraint should be reserved for situations where ___ restraint is unavailable
Chemical
Risk factors to assess the level of danger of a combative patient
- History
- Posture
- The scene
- Vocal activity
- Physical activity
Other factors to consider in assessing a patient’s potential for violence
- Poor impulse control
- History of truancy, fighting, and uncontrollable temper
- History of substance abuse
- Depression
- Functional disorder
Single most significant factor that contributes to suicide
Depression
Can occur after exposure to, or injury from, a traumatic event
Posttraumatic stress disorder (PTSD)
Symptoms of PTSD
- Feelings of helplessness
- Anxiety
- Anger
- Fear
Uncontrollable events triggered by a sound, sight, or smell
Flashbacks
Occurs when a person attempts to escape from constant internal distress or a particularly disturbing event
Dissociative PTSD
Only with the concurrence of ___ can the patient be taken into custody with an emergency petition
Medical control
