Hill: Psych Emergencies

Question 1

What sedatives can be used for agitation to protect the patient and staff?

Answer 1

• Haloperidol - best agent
• Lorazepam - may make agitation and confusion worse in elderly
• Olanzapine

Question 2

Diff dx for older person with altered behavior

Answer 2

Question 3

In someone in alcohol withdrawal, what should we look for?

Answer 3

Elevated BP and HR

CBC - check MCV

BMP - hyponatremia?

Hepatic enz

Blood alc level

Urine drug screen

Question 4

In someone in alcohol withdrawal, what is initial management?

Answer 4

IV fluid – thiamine and glucose

Meds for withdrawal – Lorazepam (good if bad liver), Diazepam, Chlordiazepoxide

Question 5

In someone with psychosis who is being violent, what is initial management?

Answer 5

• Safety – security, meds (haloperidol, lorazepam, ketamine)
• Addtl hx – fmhx, drug use
• Labs – CBC, BMP, drug screen
• Radiology – CT of head
• Consult – IM, psych, neurology

Question 6

What are some protective factors for suicidal pt?

Risk factors?

Answer 6

Protective: good clinical care, easy access to support, family and community support, young children, skill in problem solving, religious beliefs

Risk: medical cond, substance abuse, prev attempt, psych dx, burden to family, impulsive/aggressive

Question 7

Managing the suicidal patient

Answer 7

Admit to inpatient psych unit

Need affidavit of suicide attempt