Chapter 22-Psychiatric Emergencies Flashcards
What are the safety guidelines for responding to behavioral crises and psychiatric emergencies?
Assess scene Ensure you have means of communication Locate exits BSI Identify yourself Try to de-escalate patient's agitation Don't get too close to patient Don't leave patient Don't fight with patient
Define psychosis
A state of delusion in which the person is out of touch with reality
What are three causes of psychotic episodes?
Substances
Diseases
Stress
What factors influence schizophrenia?
Genetics, psychological and social influences
What are signs and symptoms of schizophrenia?
erratic speech, delusions, hallucinations, disinterest in pleasure
What is excited delirium?
A state of cognitive impairment involving hallucinations, disorientation, and delusions
What are the physical signs of excited delirium?
Hypertension, tachycardia, diaphoresis, dilated pupils
What should you do when treating a patient in excited delirium?
- Don’t touch the patient
- Ask basic questions to gauge mental status
- Take all bottles/containers if drugs suspected
- Refrain from using sirens/bright lights
- Consider calling ALS for chemical restraint
What can cause sudden death in patients experiencing excited delirium?
Metabolic acidosis Physical control measures (taser) positional asphyxia (patient is restrained in a position that blocks their airway
How do you assess the potential violence of a patient?
Scene (broken windows) History (violence in past) Position (tense, rigidity, etc.) Vocal activity Physical activity
Signs of suicidal intentions?
Depression Family history Loss of loved one Financial setback Isolation No eye contact Self-harm
What is normal body temperature?
98 degrees F
What are the five ways in which heat can travel?
Conduction Convection Radiation Evaporation Respiration
Define conduction
Heat passing between objects via direct contact
Define convection
Heat transfer between an object and circulating air
Define radiation
Heat transferred by radiant energy
Define evaporation
Heat lost from an object when water evaporated from its surface
How is heat transferred during respiration?
Warm air leaves the lungs and cool air comes in
Heat loss can be modified in three ways:
Body increases or decreases heat production
Body is moved to an area that prevents or promotes heat loss
Appropriate clothing for conditions
Define drowning
The process of experiencing respiratory impairment from submersion in a fluid
What are risk factors for drowning?
alcohol
age (infant or geriatric)
seizure disorders
unsupervised access to water
When even a small amount of water is inhaled, what happens in the body?
Spam of the larynx and vocal chords (laryngospasms)
What is the purpose of laryngospasms?
to prevent more water from entering the lungs
What happens if laryngospasms hinder ventilation?
The patient becomes hypoxic and loses consciousness, at which point the laryngospasms stop
In what situations should you associate drowning with spinal injury?
- the patient dove or fell from a tall height
- the patient is unconscious
- patient reports numbness/weakness/paralysis
How do you stabilize the c-spine of a drowning patient?
Place in supine position open airway and start ventilations slide a buoyant backboard under patient Secure head and trunk to backboard remove patient from water cover with blanket begin CPR
What are two mechanisms that the body has for ridding itself of excess heat?
Sweating and dilation of blood vessels in the skin
What temperature is the body at to be considered hyperthermic?
101 degrees F
What is a heat emergency?
when the body’s mechanisms for ridding itself of heat are overwhelmed
What two things make heat emergencies worse?
Humidity (reduces efficiency of sweating) and warm air temperature (reduces heat loss by radiation, which is the purpose of dilating superficial blood vessels)
What are the three types of heat emergencies?
Heat cramps, heat exhaustion, and heat stroke
What is the most common heat emergency?
Heat exhaustion
What are heat cramps?
Painful muscle spasms in the legs or abdominal muscles that occur after vigorous exercise due to electrolyte imbalance/loss or dehydration
What is heat exhaustion?
a heat emergency caused by stress, fatigue, hypovolemia, and/or heat exposure
What are the sign and symptoms of heat exhaustion?
dizziness/fainting/weakness onset with work cold clammy skin dry tongue and thirst weak/rapid pulse low BP elevated body temp
What is heat stroke?
A heat emergency in which the body temperature rises above the level at which tissue damage occurs, resulting in death
What are the signs and symptoms of heat stroke?
Hot/dry/flushed skin Body temp above 106 rapid/strong pulse at first but becomes weaker late onset respiratory rate AMS sweating may have stopped
How many people are killed by lightning each year in the states?
60-70
How many volts are delivered by lightning?
100 million
What is the temperature range associated with lightning?
20,000-60,000 degrees F
Who are common victims of lightning strikes?
Golfers, boaters, and swimmers
Lightning related deaths often result from _____
cardiac arrest or respiratory arrest
Lightning injuries can be categorized as:
mild, moderate, severe
What are the signs and symptoms of mild lightning injuries?
unconsciousness
amnesia
superficial burns (if any)
tingling
What are the signs and symptoms of moderate lightning injuries?
Seizures
respiratory arrest
dysrhythmias
superficial burns
What are the signs and symptoms of severe lightning injuries?
cardiopulmonary arrest
What is the emergency medical care for lightning strike accidents?
- Your safety (crouch and move away from tall objects)
- Move patient to shelter
- Reverse triage (cardiac arrest first)
- Stabilize head
- Open airway with jaw-thrust maneuver
- BVM with 100% O2
- CPR/AED
- Control bleeding
- Bandage burns en route
Why is it important to stabilize the patient’s head following lightning strike?
The current causes muscle spasms which can cause fractures in long bones or the spine
