Ch23: Behavioral Health Emergencies

Question 1

organic brain syndrome

Answer 1

a change in behavior or mental status because of a disturbance in the physical or physiologic functioning of the brain

e.g. brain trauma, drugs, alcohol, Alzheimers, dementia

Question 2

functional disorder

Answer 2

change in behavior or mental status without an identifiable root

e.g. anxiety, schizophrenia

Question 3

what questions to ask when assessing a patient’s AVPU?

Answer 3

what is your name?
what time is it?
where are you?
how can I help you?

Question 4

4 major areas to cover during History taking in a behavioral health emergency

Answer 4

1. any history of physiologic disease e.g. diabetes?
2. any history of neurologic illness?
3. any changes in life recently e.g. death of a family member
4. any medication changes

Question 5

psychosis

Answer 5

state of mind where a person is out of touch with reality

Question 6

schizophrenia

Answer 6

complex, difficult-to-identify mental illness usually found in early adulthood, where the patient has hallucinations, delusions, lack of interest in pleasure and erratic speech

Question 7

delirium

Answer 7

when patient is disoriented, disorganized, has hallucinations or delusions

Question 8

excited delirium, AKA agitated delirium

Answer 8

combination of agitation (restless and irregular physical activity) and delirium (disorientation, hallucination and disorganized thoughts)

Question 9

how to control a patient with agitated delirium who is escalating

Answer 9

call ALS for chemical restraint because a physical restraint (e.g. taser) might do more harm than good

Question 10

positional asphyxia

Answer 10

when a patient’s position (e.g. if being restrained) prevents him/her from breathing

Question 11

how to position the head of a physically uncooperative patient?

Answer 11

at 30° elevation, preferably, to keep airway open

Question 12

how should the arms of a physically uncooperative patient be placed?

Answer 12

one arm up one arm down

Question 13

whats better: restraining ankles or leg above knee?

Answer 13

leg above knee, to prevent them kneeing or injuring someone

Question 14

how to do the four-point restriction technique?

Answer 14

1. place the patient supine
2. EXTREMITIES - wrist and ankle restraints
3. UPPER LEGS - stretcher straps or sheets
4. CHEST - if there are harness-type of straps
5. regularly check airway and circulation!!

Question 15

how to cleverly ask a possibly volatile patient for cooperation

Answer 15

BABY STEPS!! Small deals

I’d like for you to go voluntarily to the ED to get good care

I want you to make a deal with me though. When we’re on the way there, you’re gonna be cooperative and work with us, so we don’t need to put any restraints on

Question 16

is it important to ask the patient if they’re hearing any voices or seeing anything else?

Answer 16

yes!

ask them what they’re seeing and tell them they’re safe

Question 17

self-mutilation vs cutting

Answer 17

cutting = deep, person has intention to bleed out & kill themselves
self-mutilation = more shallow, scars look like scratches, releases pain that allows them to feel something