Behaviourally disturbed & violent patient Flashcards
1
Q
Aims of clinical assessment
A
Diagnostic: aeitology
- psychiatric
-substance related
-organic
-personality
Evaluation of risk: can px autonomy be overrided
Assessment of arousal: does px need containment
2
Q
Clues for Differentiating
A
Hx
Previous presentations
Breath alcohol
IVDU track marks
3
Q
Investigations
A
Urine Drug:- no USE
Breath alcohol
Hx & Exam guided Investigations
4
Q
High Risk aggression/ harms
A
threats/ actual harm to self or others suicidal behaviour or ideation altered conscious state secondary to illness substance intoxication & incompetence abusive spitting pacing sweating increased voice tone loss of rational thinking
5
Q
Legal & ethical considerations
A
law upholds principle of autonomy "least restriction" informing involuntary containment & treatment orders restrain only for: -self defense - protect others from harm -pt best interest
6
Q
Management: DETERMINE DESIRED END POINT
A
- Prevention
-Verbal de escalation
-
7
Q
Containing highly aroused pt: prior planning
- police involved if weapon or need additional help
A
Team: minimum 6 people (security/ orderlies/ nurses) Leadership documentation drug administration monitoring
8
Q
Chemical restraint
A
Least traumatic 1st-PO: benzodiazepine 2nd: IM Or IV- depends on speed & blood test & risk to staff/ pt - midazolam/ diazepam - haloperidol/ droperidol - olanzepine
9
Q
Physical Restraint
A
initially floor then trolley 5 point hold -head - upper & lower limbs - PPE/ goggles by all involved Balance not to harm patient & adequate restraint Soft edge fabric shackles
10
Q
Disposition
A
OFten hours in ED
For
- assessment
- lack of gen med/ psychiatric/ detox facilities
Admission based on:
- clinical & ix
- mental health risk
- assessment & progress over time
Preventive health opportunity
Multidisciplinary care
11
Q
Final
A
Debriefing & support
reporting
documenting
followup
