Behavioral & Psychiatric Emergencies & Suicide Flashcards
Introduction: Patients may present with unexpected or dangerous behavior which may result from?
– Stress
– Physical trauma or illness
– Drug or alcohol abuse
– Psychiatric condition
What Is a Behavioral Emergency?
• Behavior
– Manner in which a person acts or performs
• Behavioral emergency
– Abnormal behavior (in a given situation)
unacceptable or intolerable to patient, family, or community
• Behavioral patients may appear confused and have altered mental status
Psychiatric Causes of Behavioral Emergencies
• Psychiatric condition (mental disorder) – Anxiety or panic disorder – Depression – Bipolar disorder – Schizophrenia
Non-psychiatric causes of altered
mental status can be life-threatening and must be considered first
- Hypoglycemia
- Hypoxia
- Stroke
- Head Trauma
- Substance Abuse
- Hypothermia
- Hyperthermia
Situational Stress Reactions: Normal reactions to stressful situations produce what emotions?
– Fear
– Grief
– Anger
What should you do when Caring for Patients with Situational Stress Reactions
- Do not rush
- Tell patient you are there to help
- Remain calm
- Keep emotions under control
- Listen to patient
- Be honest
- Stay alert for changes in behavior
Presentations of Behavioral and
Psychiatric Patients?
- Range of presentations
- Withdrawn, not communicating
- Talkative, agitated
- Bizarre or threatening behavior
- Wish to harm selves or others
What are the General Rules for Interactions?
- Identify yourself and role
- Speak slowly and clearly
- Eye contact
- Listen
- Don’t judge
- Open, positive body language
- Don’t enter patient’s space (3 ft)
- Alert for behavior changes
Assessment for the Psychiatric Patient?
- Perform careful scene size-up
- Identify yourself and your role
- Perform primary assessment
- Perform focused physical exam
- Gather thorough history
What are some of the Common Psychiatric Patient Presentations?
- Panic or anxiety
- Unusual appearance (disordered clothing, poor hygiene)
- Agitated or unusual activity
- Unusual speech patterns
- Bizarre behavior or thought patterns
- Self-destructive behavior
- Violence or aggressive behavior
Psychiatric Patient Care?
• Treat life-threatening problems • Consider medical or traumatic causes • Follow general rules for positive interactions • Encourage patient to discuss feelings • Never play along with hallucinations • Consider involving family or friends
Facts about Suicide
- Eighth leading cause of death
- Third leading cause in 15–24- year-olds
- Rising numbers in geriatric population
- Depression
- Age
- Suicide Plan
- Stress Levels
- Sudden Improvement
- Recent emotional trauma
- Substance Abuse
Things to explore during a Suicide Patient Assessment
• Explore the following possibilities – Depression – High stress levels (current or recent) – Recent emotional trauma – Age (15–25 and 40+ highest risk) – Drug or alcohol abuse – Threats of suicide – Suicide plan – Previous attempts or threats – Sudden improvement from depression
Suicide Patient Care
• Personal interaction is important • Do not argue, threaten, or indicate using force 1. Scene safety 2. Identify, treat life-threatening problems 3. Perform history, physical exam • Detailed exam only if safe 4. Reassess frequently 5. Notify receiving facility
Think about It: Suicide
• Patient is 23-year-old male. His girlfriend called 911 after a domestic dispute. He is uncooperative and refusing treatment. The girlfriend reports patient is depressed and suicidal. He owns a gun and has threatened to shoot himself.
- Can you treat the patient if he did not call?
- Should you believe the girlfriend?
- Does the patient need treatment or transport?
- Can you treat and transport the patient against his will?
- What should you do?
Things to Think about with Aggressive or Hostile Patients
• Consider clues – Dispatch information – Information from family or bystanders – Patient’s stance or position in room • Ensure escape route • Do not threaten patient • Stay alert for weapons of any type
Aggressive or Hostile Patient Assessment
- Ensure safety
- Calm patient
- Perform a thorough assessment
- Restrain patient if necessary
Aggressive or Hostile Patient Care
- Scene size-up
- Request additional help if necessary
- Seek advice from medical control if necessary
- Watch for sudden changes in behavior
- Reassess frequently
- Consider restraint
Reasonable Force and Restraint
• Reasonable force: force necessary to keep patient from injuring self or others
• “Reasonable” determined by
– Patient’s size and strength
– Type of behavior
– Mental status
– Available methods of restraint
• Some systems do not allow restraint without police or medical control orders
• Never attempt restraint without proper legal authority and sufficient assistance
Plan for Restraining a Patient
- Have adequate help
- Plan actions
- Stay beyond patient’s reach until prepared
- Act quickly
- One EMT talks to and calms patient
- Requires four persons, one at each limb
- Restrain all limbs with approved leather restraints in supine position ALWAYS
EMT’s Responsibilities for a Restrained a Patient
- EMT is responsible for restrained patient’s airway
- Ensure patient is adequately secured throughout transport
- Apply a surgical mask to spitting patients
- Reassess frequently
- Document thoroughly
What is Excited Delirium
• Extremely agitated or psychotic behavior during struggle, followed by cessation of struggling, respiratory arrest, then death
• Patient is often hyperthermic and shouting incoherently
• Usually preceded by cocaine use
• Often linked to improper restraint in a position where patient cannot expand
chest to breathe adequately (positional asphyxia)
• Be alert for this sequence of events
Transport for a Psychiatric Patient
• Not all hospitals are prepared to treat behavioral emergencies
• Choose correct facility based on
capabilities and local protocol
Medical/Legal Considerations for Psychiatric Patient
• Consent
– Refusals and restraints cause significant medical/legal risk
– Laws typically allow providers to treat and transport patients against their will if a danger to selves or others
– Local protocol may require medical control contact and/or police presence
Medical/Legal Considerations for Psychiatric Patient
• Sexual misconduct
– Behavioral patients, especially those requiring physical contact such as restraint, sometimes accuse EMS providers
– Have same-sex provider attend to patient
– Have third-party witness present at all times, on scene and during transport
Chapter Review Psychiatric Patients
• Ensure your own safety when caring for violent or potentially violent patients.
• Patients with behavioral problems are in crisis and need compassionate care.
• Always consider abnormal behavior to be altered mental status, with a medical or traumatic cause.
• Because treatment of these patients usually requires long-term management, little medical intervention can be done in
the acute situation, but how you interact with them is crucial for their continued well-being.
Remember Psychiatric Patients
• Safety is the first priority when
approaching a patient with altered mental status.
• Psychiatric and behavioral emergencies are prevalent in our society. EMTs should treat them as they would any other potentially life-threatening disorder.
• Assessment of altered mental status should rule out physical causes first.
• Psychiatric and behavioral emergencies can present differently, depending upon
the disorder. There are best practices EMTs employ in approaching, assessing,
and treating such patients.
• Follow local protocols and use appropriate procedures to restrain patients when necessary.
Questions to Consider Psychiatric Patients
• What methods help calm the patient suffering a behavioral or psychiatric emergency?
• What can you do when scene size-up reveals it is too dangerous to approach the
patient?
• What factors help assess the patient’s risk for suicide?
.
Critical Thinking Psychiatric Patients:
• You respond to an intoxicated minor who is physically aggressive, threatens suicide,
and whose parents permit you to treat, but not transport the patient. How would you manage this patient?
