Ch.23 Behavioralhealth Flashcards
An emergency in which abnormal behavior threatens a persons own health and safety or the health and safety of another person- for example, when a person becomes suicidal or homicidal, or has a psychotic episode
Behavioral health emergency
A delayed stress reaction to a prior incident. Often the result of one or more unresolved issues concerning the incident, and may relate to an incident that involved physical harm or threat of physical harm
Post-traumatic stress disorder
The point at which a persons reactions to events interfere with activities of daily living; this becomes a psychiatric emergency when it causes a major life interruption, such as attempted suicide
Behavioral crisis
The transmission of information to another person—verbally or through body language
Communication
How a person functions or acts in response to his or her environment
Behavior
The basic activities a person usually accomplishes during a normal day, such as eating, dressing, and bathing
Activities of daily living
A persistent mood of sadness, despair, and discouragement; may be a symptom of many different mental and physical disorders, or may be a disorder on its own
Depression
An illness with psychological or behavioral symptoms and/or impairment in functioning caused by a social, psychological, genetic, physical, chemical, or biologic disturbance
Psychiatric disorder
As an EMT, you are not responsible for diagnosing the underlying cause of a behavioral crisis or emergency. However, you should understand the two basic categories of diagnosis that a physician will use:_____ and ____
organic (physical) and functional (psychological).
____is a temporary or permanent dysfunction of the brain caused by a disturbance in the physical or physiologic functioning of brain tissue. Causes of___ include sudden illness; traumatic brain injury; seizure disorders; drug and alcohol abuse, overdose, or withdrawal; and diseases of the brain, such as Alzheimer dementia or meningitis.
Altered mental status can arise from a physiologic issue such as a hypoglycemia, hypoxia, impaired cerebral blood flow, and/or hyperthermia or hypothermia. In the absence of a physiologic cause, altered mental status may be an indicator of a psychiatric disorder such as bipolar disorder.
Organic brain syndrome
A change in the way a person thinks and behaves that may signal disease in the central nervous system or elsewhere in the body
Altered mental status
A____ is a physiologic disorder that impairs bodily function when the body seems to be structurally normal.
Something has gone wrong, but the root cause cannot be identified. Schizophrenia, anxiety conditions, and depression are good examples of____. The chemical or physical basis of these disorders does not alter the appearance of the patient.
functional disorder
A disorder in which there is no known physiologic reasons for the abnormal functioning of an organ or organ system
Functional disorder
A complex, difficult-to-identify mental disorder whose onset typically occurs during early adulthood. Symptoms typically become more prominent over time and include delusions, hallucinations, a lack of interest in pleasure, and erratic speech
Schizophrenia
______is a state of delusion in which the person is out of touch with reality. Affected people live in their own reality of ideas and feelings. To the person experiencing a psychotic episode, the line between reality and fantasy is blurred. That reality may make patients belligerent and angry toward others. Patients may become silent and withdrawn as they give all their attention to the voices and feelings within. Psychotic episodes occur for many reasons; the use of mind-altering substances is a common cause, and that experience may be limited to the duration of the substance within the body. Other causes include intense stress, delusional disorders, and, more commonly, schizophrenia. Some psychotic episodes last for brief periods; others last a lifetime.
Psychosis
______is a complex disorder that is not easily defined or easily treated. It affects how a person thinks, feels, and behaves. The typical onset occurs during early adulthood, between the ages of 16 and 30 years. Symptoms of the illness become more prominent over time. Some people in whom schizophrenia has been diagnosed display signs during early childhood; their disease may be associated with brain damage or may have other causes. Other influences thought to contribute to this disorder include genetics and psychological and social influences. Patients with schizophrenia may experience symptoms including delusions, hallucinations, paranoia, a lack of interest in pleasure, and erratic speech.
Dealing with a psychotic patient is difficult. The usual methods of reasoning with a patient are unlikely to be effective because the psychotic person has his or her own rules of logic that may be quite different from nonpsychotic thinking.
Schizophrenia
___is a condition of impairment in cognitive function that can present with disorientation, hallucinations, or delusions Agitation is a behavior characterized by restless and irregular physical activity. Although patients experiencing___ are generally not dangerous, if they exhibit agitated behavior they may strike out irrationally. One of the most important factors to consider in these cases is your personal safety.
If you think you can safely approach the patient, be calm, supportive, and empathetic. Be an active listener by nodding, indicating understanding, and by limiting your interruptions of the patient’s comments. It is extremely important to approach the patient slowly and purposefully and to respect the patient’s personal space. Limit physical contact with the patient as much as possible. It is also imperative that you do not leave the patient unattended, unless the situation becomes unsafe for you and your partner
Delirium
A temporary change in mental status characterized by disorganized thoughts, inattention, memory loss, disorientation, striking changes in personality and affect, hallucinations, delusions, or a decreased level of consciousness
Delirium
A medical emergency sometimes encountered in an EMS response is excited delirium.___ is also known as agitated delirium or exhaustive mania.
The symptoms of___ may include hyperactive irrational behavior with possible vivid hallucinations, which can create the potential for violent behavior. Common physical symptoms include hypertension, hyperthermia, tachycardia, diaphoresis, and dilated pupils. Because hallucinations are erroneous perceptions of reality, the patient may perceive you as a threat. Agitation is recognized as a biologic attempt to release nervous tension and can produce sudden, unpredictable physical actions in your patient.
Excited delirium
If the patient’s agitation continues, request ALS assistance so chemical restraint can be considered. Uncontrolled or poorly controlled patient agitation and physical violence can place the patient at risk for sudden cardiopulmonary arrest.
Physical agitation can lead to sudden death, thought to result from metabolic acidosis, though the cause of death is not clear.
Physical control measures (including TASERs) can contribute to sudden death in these patients. Also, this condition can be worsened by stimulant drugs (eg, cocaine) or alcohol withdrawal. Finally, ____occurs when a patient’s physical position restricts chest wall movements or causes airway obstruction. It can also cause sudden death. This condition can occur unintentionally when a patient is being physically restrained
positional asphyxia
Protocols should include only the use of restraint devices that have been approved by the state health department or local EMS agency. Restraint types can be soft, leather, or cloth. Soft restraints can include sheets, wide wristlets, and chest harnesses. Hard restraints can include plastic ties, handcuffs, or leather restraints. EMS protocols should avoid the use of hard restraints if possible. If hard restraints are approved, they will most likely be limited to the use of leather wrist restraints. The type of restraints used should not occlude circulation in the extremity and should allow the EMT to quickly remove them if the patient vomits or respiratory distress develops.
Restraints
Personnel must be properly trained in the use of restraints. Improperly applied restraints can result in severe and potentially life-threatening complications, such as positional asphyxia, aspiration, severe acidosis, and sudden cardiac death.
Restraints
If you restrain a person without authority in a nonemergency situation, you expose yourself to a possible lawsuit and to personal danger. Legal actions against you can involve charges of assault, battery, false imprisonment, and violation of civil rights. You may use restraints only to protect yourself or others from bodily harm or to prevent the patient from injuring himself or herself. In either case, you may use reasonable force only as necessary to control the patient, something that courts may define differently.
For this reason, follow local protocols and your company prehospital restraint policy, and consult medical control if needed.
You should always involve___ personnel if you are called to assist a patient in a severe behavioral health emergency, especially when restraining a competent individual against his or her will.____ may provide physical backup in managing the patient and serve as the necessary witnesses. A patient who is restrained by_____ personnel is in their custody.
law enforcement
