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EMT Test 4 > Behavioral & Psychiatric Emergencies & Suicide > Flashcards

Behavioral & Psychiatric Emergencies & Suicide Flashcards

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1
Q

Introduction: Patients may present with unexpected or dangerous behavior which may result from?

A

– Stress
– Physical trauma or illness
– Drug or alcohol abuse
– Psychiatric condition

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2
Q

What Is a Behavioral Emergency?

A

• 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

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3
Q

Psychiatric Causes of Behavioral Emergencies

A 
• Psychiatric condition (mental disorder)
– Anxiety or panic disorder
– Depression
– Bipolar disorder
– Schizophrenia
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4
Q

Non-psychiatric causes of altered

mental status can be life-threatening and must be considered first

A
  • Hypoglycemia
  • Hypoxia
  • Stroke
  • Head Trauma
  • Substance Abuse
  • Hypothermia
  • Hyperthermia
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5
Q

Situational Stress Reactions: Normal reactions to stressful situations produce what emotions?

A

– Fear
– Grief
– Anger

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6
Q

What should you do when Caring for Patients with Situational Stress Reactions

A
  • 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
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7
Q

Presentations of Behavioral and

Psychiatric Patients?

A
  • Range of presentations
  • Withdrawn, not communicating
  • Talkative, agitated
  • Bizarre or threatening behavior
  • Wish to harm selves or others
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8
Q

What are the General Rules for Interactions?

A
  • 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
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9
Q

Assessment for the Psychiatric Patient?

A
  • Perform careful scene size-up
  • Identify yourself and your role
  • Perform primary assessment
  • Perform focused physical exam
  • Gather thorough history
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10
Q

What are some of the Common Psychiatric Patient Presentations?

A
  • 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
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11
Q

Psychiatric Patient Care?

A 
• 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
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12
Q

Facts about Suicide

A
  • 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
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13
Q

Things to explore during a Suicide Patient Assessment

A 
• 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
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14
Q

Suicide Patient Care

A 
• 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
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15
Q

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.

A
  • 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?
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16
Q

Things to Think about with Aggressive or Hostile Patients

A 
• 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
17
Q

Aggressive or Hostile Patient Assessment

A
  • Ensure safety
  • Calm patient
  • Perform a thorough assessment
  • Restrain patient if necessary
18
Q

Aggressive or Hostile Patient Care

A
  • 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
19
Q

Reasonable Force and Restraint

A

• 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

20
Q

Plan for Restraining a Patient

A
  • 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
21
Q

EMT’s Responsibilities for a Restrained a Patient

A
  • 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
22
Q

What is Excited Delirium

A

• 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

23
Q

Transport for a Psychiatric Patient

A

• Not all hospitals are prepared to treat behavioral emergencies
• Choose correct facility based on
capabilities and local protocol

24
Q

Medical/Legal Considerations for Psychiatric Patient

A

• 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

25
Q

Medical/Legal Considerations for Psychiatric Patient

A

• 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

26
Q

Chapter Review Psychiatric Patients

A

• 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.

27
Q

Remember Psychiatric Patients

A

• 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.

28
Q

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?

A

.

29
Q

Critical Thinking Psychiatric Patients:

A

• 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?

EMT Test 4 (11 decks)

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