[CLMD] Psychiatric Emergencies [Hill] Flashcards
If a patient comes in with a diminished level of conciousness and a altered mental status – what do you need to suspect?
Coma, Stupor
If a patient comes in with altered mental status and has neurologic deficits with no diminished level of conciousness – what should you suspect?
Stroke, Mass Lesion
If a patient comes in with altrered mental status, no neurologic deficits, no abnormal mental status or attention span – what do you need to think of?
Thought Disorder
Psychiatric Disorder – Mania, Psychosis
If a patient comes in with altered mental status, no diminished level of conciousness, no neurologic deficit, and an abnormal attention span (mental status) – what should you be thinking of?
Delirium
Confusion
What are some life-threatning conditions that can cause abnormal adult behavior?
Hypoxia (from COPD)
Hypoglycemia
Sepsis
HTN Emergency (HTN Encephalopathy)
Wernickes Encephalopathy
Overdose
CNS Trauma
intracranial Hemorrhage
What are some common (every day) conditions that can cause abnormal adult behavior?
UTI
Pneumonia
Hyponatremia (Electrolyte Abnorm)
Medication Adverse Effects
Medication/Alcohol Withdrawl
Pyschiatric Ilness
MI
Thyroid
Stroke / Dementia
CNS Mass Lesion
What sort of workup should be done for a patient with altered mental status?
Vitals
PE
CBC, BMP, UA, Glucose, EtOH, Drug Screen
CT Head
Chest X-ray
EKG
What are some initial treament guidelines to focus on with a patient who has a altered mental status?
Keep Patient and Staff Safe
Quiet Room / Calm Convos
Sedatives –> Haloperidol, Lorazepam, Olanzapine
What should you never give an older person with altered mental status if they are agitated and/or confused?
Lorazepam
(Give Haloperidol instead)
What are some signs of Alcohol Withdrawl in a patient stem?
Becomes Violent
Confused
Tremors, tachycardia, Elevated Blood Pressure, Increased Temp
If you have a patient with suspected Alcohol Withdrawl, what are some things you might want to know History wise?
History of Withdrawl Seizures
History of Withdrawl Hallucinations
(Tells you what to expect)
What are some Lab values that would help you pinpoint the idea of a patient going through Alcohol Withdrawl?
CBC –> look at MCV, Platelets will be LOW (chronicity)
BMP –> Hyponatremia
Hepatic Fxn
Blood Alcohol Screening
Urine Drug Screen
What do you always need to give any alcoholic patient that is going through alcohol withdrawl?
What are some medications that are good for withdrawl?
THIAMINE and Glucose (prevents Wernickes –> Korsakoff)
Multivitamins
Folic Acid
Lorazepam (If Liver impaired)
Chlordiazepoxide (Good liver fxn)
Diazepam
If a patient has a psychiatric illness is this a risk factor for violent behavior?
YES!
EX:
Schizophrenia
Personality disorder
Mania
Psychotic Depression most
Psychiotic pts with a history of incarceration
Delirium
Dementia
What are some guide management techniques for keeping staff and patient safe during a violent altercation with a pschiatric pt?
Verbal De-escalation
Call Security
Meds –> Haloperidol, Lorazepam, Olanzapine, Ketamine
