Chapter 22 Flashcards by Gail I

psychiatric emergencies may be the result of: 
acute .. situation 
… 
… substances
… 
other causes

medical; mental illness; mind-altering; stress

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… is what you can see of a person’s response to the environment: his/her actions
most of the time, people respond to the enviro in reasonable way. over time, people learn to adapt to stress
sometimes stress is so great that the normal ways of coping don’t work and a crisis occurs. reactions to stress can be … or … over time.

behavior; acute; develop

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a behavioral crisis or psychiatric emergency may involve patients who exhibit agitated, violent, or uncooperative behavior or who are a danger to themselves or others. EMS is called when behavior has become …to patient, family, or community

unacceptable

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if an abnormal or disturbing pattern of behavior lasts for a month or more, it is a matter of … from a mental health standpoint.
when a psychiatric emergency arises, the patient may:
1. show .. or …
2. become a … to self or others

concern; agitation; violence; threat

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According to the National institute of Mental Health, mental disorders are common throughout the United States, affecting tens of millions of people each year. A psychiatric disorder is an illness with … or … symptoms that may result in impaired functioning

psychological; behavioral

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anxiety disorders are among the most common health disorders:

generalized …
… disorder
… and other phobias
…
…

anxiety disorder
panic
social 
PTSD
OCD

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the US mental health system provides many levels of assistance.
most psychological disorders can be handled through … visits
some people require hospitalization in … units

outpatient; specialized psychiatric

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psychiatric disorders have many underlying causes:

… and … stress such as divorce or death of a loved one
diseases such as …
… such as diabetic emergencies
.. problems such as alcohol or drug use
.. disturbances such as electrolyte imbalances

social; situational 
schizophrenia 
physical illnesses 
chemical 
biological

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an EMT is not responsible for diagnosing the … of a behavioral crisis or psychiatric emergency.
two basic categories of diagnosis: … (physical) and .. (psychological)

underlying cause; organic; functional

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… brain syndrome: a temporary/permanent dysfunction of the brain caused by a disturbance in the physical or physiologic functioning of the ..

organic; brain tissue

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causes of organic brain syndrome:
- sudden ..
- traumatic ..
- … disorders
- … and … abuse, overdose, or withdrawal
- diseases of the …, such as Alzheimer’s and meningitis
in the absence of a physiologic cause, altered mental status may be an indicator of an underlying psychiatric disorder

illness 
brain injury
seizure
drug; alcohol
brain

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… disorders: a physiological disorder that impairs bodily functions when the body seems to be structurally normal
examples: schizophrenia, anxiety conditions, depressions

functional

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All regular EMT skills are used in a behavioral crisis. other management techniques are also involved. Scene safety:
consider the scene safety and the patient’s … to the environment
take appropriate standard precautions
request any additional resources you may need early

response

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MOI/NOI

note any … or … that may contribute to the complaint or be treatment of a relevant medical condition

medications; substances

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primary assessment:
form a general impression:
begin your assessment from the doorway or from a …
perform a rapid physical exam
observe patient closely
establish a rapport with patient and family
most medical/trauma situations will include a behavioral component

distance

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primary assess cont:
airway and breathing
circulation
transport decision: unless the patient is unstable from a medical problem or trauma, prepare to … with the patient

spend time

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History taking:
investigate the chief complaint
three major areas to consider:
- is the patient’s … functioning properly?
- are … or other drugs or alcohol a factor?
- are significant …, …, or … involved?

central nervous system
hallucinogens
life changes; symptoms; illness

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history taking cont:
SAMPLE history–> You may be able to elicit info not available to the hospital staff: ask about previous episodes, treatments, hospitalizations, and medications related to behavioral problems
in geriatric patients, consider Alzheimer disease and dementia as possible causes of abnormal behavior–> identify the patient’s … mental status
use … listening to gain insight into the patient’s thinking

baseline; reflective

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secondary assessment:
physical exam–> in an unconscious patient, begin with a … to look for a reason for the unresponsiveness: rule out trauma, especially to the head; consider whether prior events such as physical agitation, use of stimulants, alcohol withdrawal, or Taser exposure may be contributing to the patient’s condition
when examining a patient with a behavioral emergency, check for track marks indicating … and for signs of ..
a conscious patient may not respond to your questions

physical exam; drug abuse; self-mutilation

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physical exam (contd):
you can tell a lot about a patient’s emotional state from:
- …
- …
- …
tears, sweating, and blushing may be significant indicators of state of mind.
a …. gaze or … eyes could mean central nervous system dysfunction

facial expressions
pulse rate
respirations
blank; rapidly moving

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transport decision:
have law enforcement/firefighters accompany you if possible
take the patient to a facility capable of caring for patients with psychiatric problems
transport the patient by ..
try to make the patient comfortable

ground

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Reassessment:
never let your guard down
if restraints are necessary, reassess and document every … minutes: …, …, .., and … function in all restrained extremities

5; respirations; pulse; motor; sensory

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interventions:
diffuse and control the situation
intervene only as much as it takes to accomplish these tasks
if you think a pharmacologic restraint is necessary, request .. as early as possible

ALS assistance

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communication and documentation:
give the receiving hospital … of the psychiatric emergency–> report whether restraints will be required when the patient arrives
document thoroughly and carefully: if restraints are used, identify which types and … they were used

advance warning; why

…: 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 may cause psychotic episodes

psychosis

schizophrenia is a complex disorder that is not easily defined/treated the typical onset occurs during early …, with symptoms becoming more prominent over time signs and symptoms: … … a lack of interest in .. … speech

``` adulthood; delusions hallucinations pleasure erratic ```

``` guidelines for dealing with a psychotic patient: determine if the situation is dangerous clearly … yourself be calm, direction, and straightforward maintain an … do not … ```

identify; emotional distance; argue

guidelines for dealing with a psychotic patient contd: explain what you would like to do involve people the patient …, such as family/friends, to gain the patient's cooperation

trusts

…: a condition of impairment in cognitive function that can present with disorientation, hallucinations, or delusions …: a behavior characterized by restless and irregular physical activity

delirium | agitation

excited delirium symptoms: - ... behavior - vivid .. - ... - ... - .. - … pupils

``` hyperactive irrational hallucinations hypertension tachycardia diaphoresis dilated ```

excited delirium: if you think you can safely approach the patient, be calm, supportive, and empathetic approach the patient … and purposefully and respect the patient's … limit … do not leave the patient …

slowly; personal space; physical contact; unattended

excited delirium contd: use careful interviewing to assess the patient --> observe the patient's ability to …, their …, …, and … if the patient has overdosed, take all med bottles/illegal substances to the med facility the patient should be transported to a hospital with psychiatric facilities if possible refrain from using … and …

communicate; appearance; dress; personal hygiene; lights; sirens

if the patient's agitation continues, request ALS assistance so … can be considered--> uncontrolled/poorly controlled patient agitation can lead to the patient's sudden death

chemical restraint

excited delirium can lead to sudden death from: sudden … physical agitation, thought to result from … … measures (including tasers) positional …

cardiopulmonary arrest metabolic acidosis physical control asphyxia

Restraint: every prehospital care transport provider should create and follow a prehospital patient restraint protocol. Protocols address: … of restraint … of restraints … provided to the patient following restraint protocols must comply with the laws of your state the restraint chosen should be the least restrictive option that ensures the safety of the patient and providers

appropriateness; types; care

restraint cont: personnel must be properly trained if you restrain a person without authority in a .. situation, you expose yourself to a possible lawsuit: assault, battery, false imprisonment, violation of civil rights improper use of restraints can lead to life-threatening conditions including …

nonemergency; cardiac arrest

restraint cont: you may use restraints only: to protect yourself/others form … to prevent the patient from … himself/herself

bodily harm; injuring

restraint cont: involve law enforcement if the patient is in a severe … crisis or … emergency before considering physical restraint, use ... de-escalation techniques

behavioral; psychiatric; verbal

restraint cont: process of restraining a patient: carry out the decision quickly there should be … people to help, one responsible for each … and one for the … there should be a team leader and plan of action use the minimum force necessary

5; extremity; head

restraint cont: the level of force will vary, depending on these factors: the degree of force that is necessary to keep the patient from injuring self and others the patient's …, …, .., and … status the type of abnormal behavior the patient is exhibiting

sex size strength mental status

restraint cont: … to the patient throughout the process treat the patient with dignity and respect if possible, a provider of the same … should attend to the patient wear appropriate .. protection

talk; gender; barrier

restraint cont: avoid direct … and respect personal space never leave a restrained person .. … restraints (both arms and both legs) are preferred monitor the patient closely--> respiratory and circulatory problems have been known to occur in restrained patients restraints applied in the field should not be removed until the patient is evaluated at the receiving facility

eye contact; unattended; four-point restraints

(potentially violent patient) history: has the patient previously exhibited hostile, overly aggressive, or … behavior? posture: how is the patient … or …? is the patient tense, rigid, or sitting on the edge of his/her seat?

violent; sitting; standing

(potentially violent patient) the scene: is the patient holding or near potentially … objects? vocal activity: which kind of … is the patient using? loud, obscene, erratic, and bizarre speech patterns usually indicate emotional distress

lethal; speech

(potentially violent patient) physical activity: most telling factor of all a patient requiring careful watching is one who: has .. muscles, clenched fists, or glaring eyes is … cannot … is fiercely protecting …

tense; pacing; sit still; personal space

(potentially violent patient) other factors to consider: poor … control history of truancy, fighting, and uncontrollable temper history of … … … disorder (if the patient tells you voices are telling him/her to kill, believe it)

impulse; substance abuse; depression; functional

suicide: …. is the single most significant factor that contributes to suicide it is a common misconception that people who threaten suicide never commit it--> threatening suicide is an indication hat someone is in a crisis that he/she cannot handle alone immediate intervention is necessary

depression

suicide cont: be alert to these warning signs:' air of tearfulness, sadness, deep despair, or hopelessness avoiding …, speak ..., and project a sense of vacancy unable to talk about the future suggestion of suicide having any plants related to death

eye contact; slowly

``` suicide cont: consider these additional risks: are there any … objects nearby? is the environment unsafe? is there evidence of … behavior? is there an imminent threat to the person/others? ```

unsafe; self-destructive

``` suicide cont: is there an underlying … problem? are there cultural/religious beliefs promoting suicide? has there been …? a suicidal patient may be … as well ```

medical; trauma; homicidal

(PTSD) an estimated 7 to 8% of the gen pop will experience PTSD at some point in their lives. military personnel who have experienced … have a high incidence of PTSD. Symptoms of PTSD include feelings of: helplessness, anxiety, anger, fear

combat

(PTSD) people with PTSD: may avoid … of the trauma suffer constant … --> heart rate increases, pupils dilate, and systolic blood pressure increases can relive the traumatic event through thoughts, nightmares, and flashbacks

reminders; nervous system arousal

(PTSD) .. have an increased risk of suicide veterans may develop a variety of physical conditions related to combat injuries combat veterans have a higher incidence of … health care providers should eliminate excess noise, refrain from touching/doing anything to the veteran without an explanation, and keep their … equipment far away

veterans; traumatic brain injury; diesel

``` (PTSD) caring for the combat veteran: requires a unique level of understanding: be careful how you … your questions use a clam, firm voice, but be in … respect a veteran's … limit the number of people involved ask about suicidal intentions ```

phrase; charge; personal space

(PTSD) caring for the combat vet: ' ensure that there is nothing the patient can access and use as a weapon … may simply escalate the problem

physical restraints

more complicated with a patient undergoing behavioral crisis/psychiatric emergency you must decide wether the patient needs immediate emergency medical care: ' the patient may … your attempt to provide care never leave the patient alone request … personnel to assist with the patient

resist; law enforcement

… is assumed with a patient who is not mentally competent to grant consent consent matters are not always clear-cut in psychiatric emergencies--> if you aren't sure, request the assistance of … or guidance from ...

implied consent; law enforcement; medical control

the emt has limited legal authority to require a patient to undergo emergency med care when no … exists competent adults have the right to refuse care

life-threatening emergency

in psychiatric acases, a court of law would probably consider your actions in providing … to be appropriate--> a patient who is in any way impaired may not be considered competent maintain a high index of suspicion about the patient's condition err on the side of … and …

life-saving care; treatment; transport