EMER 198 Medical 2 Flashcards
Behavioural disorder and examples
interferes with a persons ability to perform activities of daily living Mental health problem Depression Borderline, personality disorder
Behavioural emergency
exist when the abnormal behaviour threatens a persons health and safety with the health and safety of another Imminent to have harm on others
Psychiatric emergency
person becomes suicidal, homicidal, or has a psychotic episode in which a person often experiences delusions and hallucinations
DelusionsHallucinations
Delusions: false beliefs Hallucinations: false perceptions
Causes of abnormal behaviour
Diabetes, seizure disorder, severe infections, metabolic disorders, head injury, stroke, alcohol, tumours in the brain and drugs may all cause derangements in behaviour
organic brain syndrome
abnormal behaviour are actually suffering from physical illness or are under the influence of a substance that effects normal cerebral function
Toxic and deficiency states
Drug induced psychosesNutrition disorders Poisoning with bromide or other heavy metals Kidney failure Liver failure
Drug induced psychoses especially from:
Digitalis Steroids Disulfiram Amphetamines LSD, PCP and other psychedelics
Delirium
Is a symptom not a disease Temporary/reversible condition that results in rapid changes to behaviour May complicate the assessment of the underlying problem
Excited delirium
is a controversial condition that arises typically in male subjects with a history of mental illness and/or acute or chronic drug abuse, particularly stimulant drugs. Some groups claim that this condition was “invented” to cover up the use of excessive force by law enforcement the American College of Emergency Physicians has accepted excited delirium as a unique syndrome, despite the World Health Organization, and the American Psychiatric Association failing to acknowledge it as a medical or psychiatric diagnosis.
Excited delirium is characterized by a combination of the following:
• Delirium • Agitation or anxiety • Violent bizarre behaviour • Inappropriately clothed • Hallucinations or visual disturbances • Inability to feel pain • Superhuman strength • Elevated body temperature (hyperthermia) • Excessive sweating even in cold weather
Paramedics should consider the following when dealing with a patient displaying the signs of excited delirium:
• Are we safe? • Consider the need for physical restraint and sedation (ALS skill). Physical restraint is something that should be conducted with appropriate resources and preferably the assistance of law enforcement. • Is the patient safe? • Arms, legs, and body securely affixed to the cot? • If the choice to restrain is made are we restraining the patient in such a way to allow for breathing and airway control? • If ALS sedates the patient are we in a position to assist with breathing and provide supplemental oxygen? • What else could be going on? • remember that we need to rule but all other conditions before deciding on one specifically.
Psychosocial causes
Individuals may develop abnormal reactions to stressful psychosocial events or developmental influence
When exposed to stress this causes a crisis most of the time the patient will resolve the crisis in one of two ways they are:
Coping with it they will find ways to alter the situation to make it less stressful Attempt to alleviate the discomfort by escaping including drug, alcohol, psychiatric symptoms and in some cases suicide
Categories of psychiatric disorders
Cognitive Thought Mood Neurotic Substance related disorders and addictive behaviour Somatoform Factitious Impulse control Personality
Disorders of consciousness
Distractibility and inattention Confusion Delirium Stupor and coma
Disorders of motor activity
Restlessness steryotyped movement compulsionsretarted movements
Stereotyped movementsCompulsions
Stereotyped movements: involves the repetition of movements that do not seem to serve any useful purpose Compulsions: repetitive actions that are carried out to relieve the anxiety of obsessive thoughts
Neologisms
words that the patient invents
Echolalia
the patient echos the words of the examiner
Retardation of thought
it seems to take a very long time to get from one thought to the next
Circumstantial thinking
the patient includes many irrelevant details in his or her account of things
Preservation
refers to the repetition of the same idea over and over again
Delusions of persecution
the individual believes that others are plotting against him or her
Delusions of grandeur
the patient believes he or she is someone of great importance
AmnesiaConfabulation
Amnesia: the loss of memory Confabulation: patients with severe memory deficits from organic brain disease will invent experiences to fill in the gaps
IllusionHallucination
Illusion: miss interpretation of sensory stimuli Hallucination: it’s a perception that has no basis in reality and occurs without any external stimuli
Generalized anxiety disorder
When a person worries about everything for no particular reason or if the worrying is unproductive in the individual cannot decide what to do about an upcoming situation Must be present for more days than not for a period of at least six months and the worry must be difficult to turn off or control
Phobias
Focusses all his or her anxieties onto one class of objects or situations Confronted with the feared object or situation the person experiences intolerable anxiety
Panic disorder Agoraphobia
Characterized by sudden usually unexpected and overwhelming feelings of fear and dread accompanied by a variety of other symptoms Agoraphobia: the fear of going into public places : the fear of going into public places
Depression mnemonic
GASP PIPES: guilt, appetite, sleep disturbance, paying attention, interest, psychomotor abnormalitites
Manic behaviour
One of the most striking psychiatric conditions The manic patient is more likely to report being on top of the world I’ve never felt any better when they are not
Mental status examination
COASTMAP: consciousness, orientation, activity, speech, thought, memory, mood, affect and perception
The mental exam on a manic patient
Consciousness: easily distracted Orientation to place and time: disrupted Activity: hyperactive almost always report is significantly decreased need for sleep and I go for days without sleeping Speech: pressured and rapid very talkative Thought: flight of ideas and delusions patient may report of butter racing Affect: oh hallmark of mania the patient seems to be on a high and is usually cheerful Perception: may be disrupted
Somatoform disorders
People who are overly concerned with their physical health and appearance
Munchausen syndrome
intentionally getting sick for attention
Psychosis
state where patient is out of touch with reality and are focused on their version of it
schizophrenia
complex disorder that is neither easily defined nor readily treated Typical onset occurs during early adulthood May experience positive negative or disorganized symptoms
Positive symptomsNegative symptomsDisorganized symptoms
Positive symptoms: include delusions and hallucinations Negative symptoms: include apathy, mutism, a lack of interest in pleasure Disorganized symptoms: erratic speech, emotional response and motor behaviour
Paranoid schizophrenia
characterized by delusions or hallucinations usually centred on a specific theme
Disorganized schizophrenia
usually display the wrong emotion for a particular situation and have disorganize speech behaviour
Catatonic schizophrenia
Display odd motor activity such as strange expressions in their face or remaining rigid
Mental Status examination for the psychotic patient
Consciousness: awake and alert but may be easily distracted Orientation: may be disoriented as to time and place in severe cases Activity: most commonly accelerated with agitation and hyperactivity bizarre stereotyped movement are common Speech: may be pressured or sound strange because I’m an usual words that the patient has invented Thought: loosening associationsthought insertion:thought withdrawl: affect and mood: likely to be disturbed in psychosis perception: auditory hallucinations are common in psychosis
loosening associations:thought insertion: thought withdrawl:
loosening associations: the logical connection between what idea in the next becomes obscure at least a listener thought insertion: the believe that thoughts are being thrust into his or her mind by another person thought withdrawl: the believe that thoughts are being removed
Medication for psychosis
Separated into two groups Atypical antipsychotic (AAP) agents Traditional antipsychotic agents
Atypical antipsychotic (AAP) agents
Acute dystonic reaction: the patient develops muscle spasms of the neck, face and back within a few days of starting treatment with the medication
Traditional antipsychotic agents
Atropine like effects: dry mouth, blurred vision, urinary retention and cardiac dysrhythmias
Attention Deficit Disorder
neurobiological condition characterized by developmentally inappropriate level of attention, concentration, activity, distractibility, impulsivity, and in the case of ADHD, hyperactivitythe most commonly diagnosed childhood behavioural disorder with symptoms beginning by three years of age
ADHD Signs and Symptoms
Does not pay close attention to details • Makes careless mistakes at work, school, or other activities • Difficulty maintaining attention on tasks or play activities • Difficulty organizing tasks • Easily distracted • Unable to follow more than one instruction at a time • Talks excessively • Has trouble participating in “quiet” activities
Autism spectrum disorder
is a complex developmental disorder that appears in the first three years of life, but may be diagnosed much later. Autism affects the brain’s normal development of social and communication skills. Core features include impaired social interactions, impaired verbal and nonverbal communication, and restricted and repetitive patterns of behaviour.
autism Signs and Symptoms
• Unusual responses to the environment • Impaired social interaction • Repetitive movements such as rocking and twirling • Self-abusive behavior • Gross deficits in language development and speech patterns • Frequently associated findings: • Congenital blindness • Mentally impaired • Normal or even exceptional development with memory or math calculations • Grand mal seizures before adolescence
Anxiety meds overdose signs and symptoms
Severe hypoventilation Severe hypotension Bradycardia Slurred speech Altered mental status Impaired coordination
SSRIs
Side effects: headaches, dizziness, sexual dysfunction,nausea, diarrhea and insomnia
Heterocylic antidepressents
Side effects: anti cholinergic (dry) or cardiotoxic ( ecg changes and dysrhythmias)
Monoamine oxidase inhibitors (MAOIs)
Recommended for aytipical major depressive episodes Side effects: CNS irritabili
Hypothalamus
mediator between nervous system and endocrine system
Pituitary gland(base of brain)
master gland- responsible for controlling others
ThyroidParathyroid:
Thyroid: secretes thyroxine- main metabolic hormone Parathyroid: regulates calcium
Adrenal glands
cortical steroids
Medulla
epi and nor epi
Pancreas
controls beta and alpha cells
Beta cells
releases insulin
Alpha cells
release glucagon
pathophysiology of Type 1 diabetics (insulin dependant)
Cell takes glucose into cell to create energy but insulin dependent diabetics’ cells don’t let glucose in so it uses fat as energy which is converted to fatty acids The fatty acids create a lot of ketones as by products Ketones convert to hydrogen ions, CO2 and heat This can lead to diabetic ketoacidosis
Diabetic Ketoacidosis
Life threatening Occurs when certain acids accumulate in the body DKA occurs when the cells experience famine Because the cells are lacking glucose to convert to energy they begin to use other sources for energy The metabolism of fat causes the build up of acids and ketones The body also experiences a loss of water and electrolytes due to high levels of glucose in the blood
PolyuriaPolydipsiaPolyphagia
Polyuria: Compensating mechanism of too much sugar is to pee it out Polydipsia: drinking lots of water Getting dehydrated from so much peeing Up to 6L of dehydration Polyphagia: eating excessive amounts of food Cells don’t get enough sugar trying to eat more
Signs and symptoms of DKA
PolyuriaPolydipsiaPolyphagiaTachycardia: consequence of dehydration trying to get sugar Kusmals breathing: deep and fast breathing trying to blow of co2 Warm dry skin
Hyperosmolar nonketotic coma (HONK)
BGL greater than 33MMOL/L A metabolic disorder that occurs primary in type 2 diabetes ‘Characterized by hyperglycemia, hyperosmolarity and abscence of ketosis HONK and DKA tend to overlap and often observed simultaneously HONK develops secondary in patients with diabetes who have some secondary illness that leads to reduced fluid intake
Diabetes Mellitus
A metabolic disorder in which the bodys ability to metabolize simple carbohydrates (glucose) is impaired
inability to sufficiently metabolize glucose because of
1)The pancreas does not produce enough insulin 2)The cells do not respond to the effects of the insulin
Type 1
Common in children Also know as juvenile diabetes Most type 1 patients produce too little to no insulin at all –Viral response attacks Tcells and beta cells in pancreas –Autoimmune disorder These patients require daily doses of insulin to: –Regulate sugar levels –Prevent the formation of ketoacids Diabetic patients will use diet control to assist in management of their condition
Signs and symptoms type 1
Sudden weight lost- veryhungy Frequent urination Numbness tingling Blurried vission
Type 2
Most common Adult onset diabetes Insulin resistanceTypically medications, exercise and diet control are used to manage
type 2 signs and symptoms
Fatigue Nausea Frequent urination Thirst Unexplained weight loss Blurred vision Slow healing Cranky Confused Shaky Unresponsiveness Seizure
Hypoglycemia
Low blood sugar Less than 4.5mmol/l Usually the result of taking too much insulin or oral diabetic medicine, too little food or both This causes the cells and brain to be starved of glucose
Hypoglycemia signs and symptoms
Tachycardia Sweating Hunger Headache Confusion Memory loss Incoordination Dilated pupils Slurred speech Seizure/coma Severe cases may present as a stroke Cool and clammy needs some candy
Hyperglycemia signs and symptoms
High blood glucose level Most common presenting feature of diabetes mellitus Typically the result of excessive food intake, insufficient insulin dosages, infection or illness If this is left untreated may lead to DKA Caused by excessive efood intake, insufficient insulin dosages, infection or illness, injury, emotional stress Hot and dry- sugar is high