Clin - Psych Emergencies

Question 1

if a patient comes in with AMS and has diminished level of consciousness, what is the likely diagnosis

Answer 1

coma, stupor

Question 2

if a patient comes in with AMS, without diminished level of consciousness, but WITH acute neurologic deficit, what is the likely diagnosis

Answer 2

stroke, mass lesion

Question 3

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

Answer 3

confusion, delirium

Question 4

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

Answer 4

thought disorder, psych disorder

Question 5

what are the most frequent disorders causing altered behavior

Answer 5

• UTI
• pneumonia
• electrolyte abnormality
• endocrine dz (thyroid)
• MI
• strokes w/o motor deficits
• FNS mass lesions
• med adverse effects or withdrawal syndromes

Question 6

what is the ER workup for a patient presenting with agitation/confusion

Answer 6

• vitals (O2)
• PE (look for specific neuro deficits)
• labs (CBC, BMP, UA, glucose, ETOH/drugs)
• radiology (CT head, CXR)
• EKG

Question 7

what medication should you give to an elderly patient presenting with agitation/confusion

Answer 7

haloperidol

NOT lorazepam or olanzapine

Question 8

what are the three main drugs listed for pts in the ED with confusion/agitation

Answer 8

• haloperidol
• lorazepam
• olanzapine

Question 9

what is the dosage of haloperidol

Answer 9

2-5mg IM every 15-30mins

Question 10

what is the dosage of olanzapine

Answer 10

2.5-5mg IM every 3 hours

Question 11

what is the ER workup for a patient presenting with likely alcohol intoxication and violence with tachy, HTN, and tremors

Answer 11

• vitals (BP and HR)

- labs (CBC - MCV and platelets, BMP - hyponatremia, hepatic function, blood alcohol, urine drug)

Question 12

initial management in the ER for patient presenting with likely alcohol intoxication and violence with tachy, HTN, and tremors

Answer 12

• IV fluids (thiamine and glucose)

- multivitamins, folic acid

Question 13

what are the medications used for patients in withdrawal

Answer 13

• lorazepam
• diazepam
• chloridazepoxide

Question 14

what drug should you give to a patient in withdrawal with known liver impairment

Answer 14

lorazepam

Question 15

management of a violent patient

Answer 15

• verbal de-escalation
• call security and physically restrain patient
• medications
• obtain additional hx

Question 16

medications for violent patients

Answer 16

• haloperidol
• lorazepam
• olanzapine
• ketamine

Question 17

workup for pt with altered behavior and violence

Answer 17

• labs (urine drug, CBC, BMP)
• radiology (CT head)
• consults (IM, psych, neurology)

Question 18

management for a suicidal patient

Answer 18

• admit pt to psych unit

- affidavits of pts suicide attempt

Question 19

how to evaluate a suicidal patient

Answer 19

• 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)