Clin - Psych Emergencies Flashcards
if a patient comes in with AMS and has diminished level of consciousness, what is the likely diagnosis
coma, stupor
if a patient comes in with AMS, without diminished level of consciousness, but WITH acute neurologic deficit, what is the likely diagnosis
stroke, mass lesion
if a patient comes in with AMS, without diminished level of consciousness or neurologic deficit, but WITH abnormal mental status testing/attention span, what is the likely diagnosis
confusion, delirium
if a patient comes in with AMS, without diminished level of consciousness, neurologic deficit, or abnormal mental status testing/attention span, what is the likely diagnosis
thought disorder, psych disorder
what are the most frequent disorders causing altered behavior
- UTI
- pneumonia
- electrolyte abnormality
- endocrine dz (thyroid)
- MI
- strokes w/o motor deficits
- FNS mass lesions
- med adverse effects or withdrawal syndromes
what is the ER workup for a patient presenting with agitation/confusion
- vitals (O2)
- PE (look for specific neuro deficits)
- labs (CBC, BMP, UA, glucose, ETOH/drugs)
- radiology (CT head, CXR)
- EKG
what medication should you give to an elderly patient presenting with agitation/confusion
haloperidol
NOT lorazepam or olanzapine
what are the three main drugs listed for pts in the ED with confusion/agitation
- haloperidol
- lorazepam
- olanzapine
what is the dosage of haloperidol
2-5mg IM every 15-30mins
what is the dosage of olanzapine
2.5-5mg IM every 3 hours
what is the ER workup for a patient presenting with likely alcohol intoxication and violence with tachy, HTN, and tremors
- vitals (BP and HR)
- labs (CBC - MCV and platelets, BMP - hyponatremia, hepatic function, blood alcohol, urine drug)
initial management in the ER for patient presenting with likely alcohol intoxication and violence with tachy, HTN, and tremors
- IV fluids (thiamine and glucose)
- multivitamins, folic acid
what are the medications used for patients in withdrawal
- lorazepam
- diazepam
- chloridazepoxide
what drug should you give to a patient in withdrawal with known liver impairment
lorazepam
management of a violent patient
- verbal de-escalation
- call security and physically restrain patient
- medications
- obtain additional hx
medications for violent patients
- haloperidol
- lorazepam
- olanzapine
- ketamine
workup for pt with altered behavior and violence
- labs (urine drug, CBC, BMP)
- radiology (CT head)
- consults (IM, psych, neurology)
management for a suicidal patient
- admit pt to psych unit
- affidavits of pts suicide attempt
how to evaluate a suicidal patient
- evaluate for risk factors (previous attempts, psych dx, substance abuse, lack of supports, cultural beliefs)
- evaluate for protective factors (effective care, easy access to care, support, young children, cultural beliefs)
