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QAS Clinical > Behavioural Disturbances > Flashcards

Behavioural Disturbances Flashcards

1
Q

Define acute behavioural disturbance…

A

Behaviour that puts a patient or others at immediate risk of serious harm

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2
Q

Aims of managing a patient with ABD?

A
  1. Reduce risk of harm
  2. Ascertain the most likely cause of ABD
  3. Transfer to definitive care
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3
Q

The _____ restrictive means possible should be used when managing a patient with ABD.

A

Least

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4
Q

The initial management strategy involving a patient with ABD is…

A

Verbal de-escalation

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5
Q

What are some common behaviours seen in ABD?

A
  • Agitation
  • Panic
  • Yelling
  • Disorganised behaviours
  • Threatening self or others
  • Aggressive or violent behaviours
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6
Q

There are several possible causes of ABD, and in some cases the cause can be ______________.

A

Multifactorial

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7
Q

What are the five general categories of causes of ABD?

A
  1. Substance related
  2. Organic
  3. Psychiatric
  4. Situational
  5. Behavioural
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8
Q

Examples of substances that can cause ABD?

A
  • Alcohol
  • Hallucinogens
  • Psychostimulants
  • Benzodiazepines
  • Ketamine
  • LSD
  • Cannabis
  • Other drugs
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9
Q

Examples of organic conditions that can cause ABD?

A
  • Encephalitis
  • Meningitis
  • Infections
  • Encephalopathy (especially in liver and/or renal failure)
  • Seizures
  • Hypoglycaemia
  • Electrolyte disturbances
  • Hypoxia
  • Head injury
  • Acute delirium
  • Dementia
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10
Q

Examples of psychiatric conditions that can cause ABD?

A
  • Schizophrenia
  • Bipolar disorder
  • Psychotic disorders
  • Anxiety disorders
  • Borderline and antisocial personality disorders
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11
Q

Examples of situational causes of ABD?

A
  • Stress
  • Pain
  • Inability to communicate effectively
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12
Q

Examples of behavioural disorders that can cause ABD?

A
  • Exacerbation of intellectual disability
  • Impulse control disorders
  • Autism
  • Acquired brain injury
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13
Q

What is the tool used to guide decision making in regards to a patients anxiety and agitation?

A

Sedation assessment tool

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14
Q

In ABD what factors should alert the clinician that there is a possibility of an underlying medical condition?

A
  • First presentation in a patient >45
  • Abnormal VSS
  • Focal neurological deficits
  • Decreased awareness of surroundings
  • Difficulty paying attention
  • Absence of a clear trigger
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15
Q

Types of restraint?

A
  • Physical
  • Mechanical
  • Pharmacological
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16
Q

Are QAS officers austhorised to apply mechanical restraints?

A

No. If mechanical restraints are applied by QPS or QCS the agency must be present with the patient at all times.

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17
Q

A physically restrained patient should be placed in which position?

A

Lateral with hands infront

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18
Q

Whilst monitoring a patients airway while physically restrained clinicians should ensure…

A

Airway is clear and no difficulty breathing

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19
Q

Why should patients not be placed in the prone position when physically restrained?

A

Risk of positional asphyxia

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20
Q

Why should patients not be positioned supine when physically restrained?

A

Risk of aspiration

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21
Q

When physically restraining a patient it is important to not?

A
  • Restrict airway or circulation
  • Apply direct pressure to head, neck, chest, back, abdomen, pelvis
  • Block mouth or nose
  • Flex head towards knees
  • Inflict pain
  • Obstruct mouth or ears (ability to communicate)
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22
Q

A physically restrained patient should be visually monitored for signs of physical and psychological stress, including…

A
  • Distress
  • Difficulty breathing
  • Continual struggling
  • Facial grimacing
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23
Q

How often should the physically restrained patient have VSS taken?

A

5 minutely

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24
Q

How often should a physically restrained patient have temperature taken?

A

15 minutely

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25
Q

Physical restraint should be applied for the ________ time possible.

A

Shortest

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26
Q

Categories of risk associated with physical restraint?

A
  • Positional
  • Pressure
  • Exertional
  • Patient’s health (co-morbidites and toxicology)
27
Q

A patient must not be placed in the prone position for longer than?

A

2 minutes

28
Q

If a patient is required to be positioned supine for a short period where should the clinician be situated?

A

At the patients head

29
Q

Mechanism of pressure related risk to the chest, back and abdomen?

A

Weight impacts ability of diaphragm to move - leads to hypoventilation and respiratory failure

30
Q

Mechanism of pressure related risk to the abdomen and pelvis?

A

Increases intra-abdominal pressure which decreased venous return, resulting in cardiovascular compromise

31
Q

Sudden, unexpected death can occur in circumstances where a patient suffering from extreme agitation or ‘_______ ________’, is physically restrained.

A

Excited delirium

32
Q

Which factors can contribute to sudden death in excited delirium patients?

A
  • Forceful or prolonged struggle
  • Exertion induced hyperthermia and acidosis
  • Psychostimulant drug toxicity
  • Underlying heart disease
  • Positional asphyxia
  • Restraint technique
  • Obesity
33
Q

Conducted energy weapons cause _____________ __________ through application of an electric current - which incapacitates a person and causes pain.

A

Neuromuscular disruption

34
Q

Due to strong muscular contractions, CEWs can cause secondary injuries, including…

A
  • Fractures
  • Spinal injuries
  • Head injuries
  • Soft tissue injuries
  • Hyperthermia
35
Q

Can a taser cause cardiac arrest?

A

Yes, on rare occasions

36
Q

CEW patients must be transported if?

A
  • Probes in face, neck, groin
  • Unable to remove probes due to resistance
  • Non QPS CEW
  • Known stimulant ingestion
  • Significant cardiac history
  • Known/suspected injuries
37
Q

Does current literature support 12-lead ECG acquistion in patients with CEW exposures of less than 15 seconds if patient is asymptomatic, awake and alert.

A

No

38
Q

How do you remove taser probes?

A
  1. Explain procedure
  2. Gloves, glasses
  3. Confirm probe not in face, neck, genitals
  4. Cut wire
  5. Stabilise skin non-dominant hand
  6. Pull probe/s until removed DO NOT twist
  7. Examine probe for completeness
  8. Probe into sharps
  9. Antimicrobial swab
  10. Consider wound dressing
39
Q

The chance of infection with taser probe implantation is…

A

Extremely low

40
Q

CEW patients can be left in the care of QPS if they…

A
  • QPS CEW
  • Probes removed and intact
  • No requirement for medical/mental health assessment
  • No evidence of stimulant ingestion
  • No significant cardiac history
  • No known or suspected injuries
41
Q

Examples of factors that can contribute to suicidal ideation?

A
  1. Individual factors
    - Job loss/unemployment
    - Legal/criminal problems
    - Financial problems
    - Stressful life events
    - Previous suicide attempts
    - Serious illness
    - Mental illness
    - Substance misuse
  2. Relationship factors
    - Relationship break-up/loss
    - Bullying
    - Exposure to violence
    - Adverse childhood events
    - Family history of suicide
  3. Social factors
    - Barriers to accessing health care
    - Suicide cluster
    - Stigma associated with help seeking
    - Access to lethal means
42
Q

Clinical features in suicidal patients?

A
  • Talking about death or suicide
  • Seeking methods of self harm
  • Hopelessness
  • Changes in drug/alcohol use
  • Uncontrolled emotions
  • Reckless behaviour
  • Changes in sleep pattern
  • Feelings of isolation
  • Social withdrawal
  • Putting affairs in order
  • Giving away possessions
  • Anxiety or agitation
  • Sudden mood changes
  • Talking about being a burden
43
Q

Protective factors for suicide risk?

A
  • Ambivalence
  • Future orientation
  • Engagement in help seeking behaviours
  • Coping and problem solving skills
  • Support systems
  • Availability of physical and mental health care
  • Limiting access to lethal means
44
Q

A suicide safety plan can include…

A
  • EEA
  • Transport to a place of safety
  • Being in the care of a reliable and capable person who is willing to provide support and supervision
  • Referral for further assessment and safety management
  • Provision of support and helping services (Lifeline, local mental health service, Beyondblue)
45
Q

If the QAS clinician believes a safety plan can manage risk in suicidal patients, the clinician must…

A
  • Obtain advice from MHLS
  • VIRCA
46
Q

The MSE evaluates a patients thought processes at a particular ____.

A

Time

47
Q

Can an MSE be used to diagnose a psychiatric condition?

A

No

48
Q

Indication: MSE?

A

Behavioural disturbances

49
Q

Components of the MSE?

A
  • Appearance
  • Behaviour
  • Speech
  • Mood
  • Affect
  • Thought form
  • Thought content
  • Perception
  • Insight and judgement
50
Q

The SAT is a useful tool for measuring _________ or ________ in patients with ABD.

A

Agitation, sedation

51
Q

Indication: SAT?

A

All patients with ABD at regular intervals

52
Q

Following sedation administration a SAT score should be assessed how often?

A

5 minutely

53
Q

Is it mandatory to document regular SAT scores on all ABD patients?

A

Yes

54
Q

EEA criteria?

A
  • Behaviour indicates immediate risk of serious harm
  • Risk as a result of a major disturbance in persons mental capcity
  • Person requires urgent examination and care for the disturbance
55
Q

Can a patient be transported to a watchhouse under an EEA?

A

No

56
Q

Procedure for EEA?

A
  1. Confirm criteria met
  2. Inform patient
  3. Safely transport
  4. Make EEA once at destination
  5. Complete EEA prior to leaving destination
  6. Document any force used
57
Q

Can the MHLS approve a patient being transported to a place of care under an EEA that is not a public health service?

A

Yes, under approval - also required approval from OpCen

58
Q

Examples of ‘at immediate risk of serious harm?’

A
  • Threatening suicide
  • Self harm or threatening self harm
  • Reckless behaviour
  • Deterioration in mental state
  • Illness symptomology (mania, psychosis)
  • Aberrant behaviour
59
Q

What must a patient be informed when placed under an EEA?

A
  • They are being detained by QAS
  • They will be transported by ambulance to hospital
  • They will be detained at hospital for up to 6 hours
  • Examined by a doctor at the hospital
60
Q

What are the three medications indicated for sedation of an ABD patient within the QAS?

A
  • Droperidol (ACP2 + CCP)
  • Midazolam (ACP2 + CCP)
  • Ketamine (CCP only)
61
Q

Roles within an emergency sedation?

A
  • Supervisor (senior clinician) - complete checklist and pre-sedation briefing
  • Assistant - administer medication and continually reassess
62
Q

Indication: Emergency Sedation?

A
  • SAT 2 more AND
  • Behaviour indicates imminent risk of serious harm to self or others AND
  • Verbal de-escalation has failed
63
Q

Contraindications for emergency sedation?

A
  • Suffering or suspected to be suffering haemodynamic instability (hypotension, arrhythmias, shortness of breath, decreased peripheral perfusion, cyanosis)
  • Compromised airway
  • Contraindications for the sedation medication
64
Q
A

QAS Clinical (1 decks)

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