Mental Health

Question 1

Who enacts a Section 19?

Answer 1

Doctor or accredited person

Question 2

Who enacts a Section 22?

Answer 2

Police

Question 3

Who enacts a Section 20?

Answer 3

Ambulance Officer

Question 4

Who enacts a Section 24?

Answer 4

Magistrate

Question 5

Who enacts a Section 80?

Answer 5

Arrangement between facilities

Question 6

When can we enact a Section 20?

Answer 6

If the person appears to be mentally ill or mentally disturbed and that it would be beneficial to the person’s welfare to be dealt with in accordance with this Act.

Question 7

What are the 2 questions to ask yourself before enacting a Section 20?

Answer 7

Does the person appears to be either Mentally ill or Mentally disturbed?
Would it be beneficial to the person’s welfare to be dealt with in accordance with the ACT?

Question 8

What statement should precede the description in the S20?

Answer 8

At the time of assessment

Question 9

+3 Sedation Assessment Tool (SAT) behaviour score description

Answer 9

combative, violent, out of control

Question 10

+2 Sedation Assessment Tool (SAT) behaviour score description

Answer 10

very anxious and agitated

Question 11

+1 Sedation Assessment Tool (SAT) behaviour score description

Answer 11

very anxious/restless

Question 12

0 Sedation Assessment Tool (SAT) behaviour score description

Answer 12

Awake/calm and cooperative

Question 13

-1 Sedation Assessment Tool (SAT) behaviour score description

Answer 13

asleep

Question 14

-2 Sedation Assessment Tool (SAT) behaviour score description

Answer 14

physical stimulation

Question 15

-3 Sedation Assessment Tool (SAT) behaviour score description

Answer 15

no response to stimulation

Question 16

+3 Sedation Assessment Tool (SAT) verbal score description

Answer 16

continual loud outbursts

Question 17

+2 Sedation Assessment Tool (SAT) verbal score description

Answer 17

loud outbursts

Question 18

+1 Sedation Assessment Tool (SAT) verbal score description

Answer 18

normal/talkative

Question 19

0 Sedation Assessment Tool (SAT) verbal score description

Answer 19

speaks normally

Question 20

-1 Sedation Assessment Tool (SAT) verbal score description

Answer 20

slurring or prominent slowing

Question 21

-2 Sedation Assessment Tool (SAT) verbal score description

Answer 21

few recognisable words

Question 22

-3 Sedation Assessment Tool (SAT) verbal score description

Answer 22

nil

Question 23

What are some acute and medical causes of behavioural disturbance?

Answer 23

• Acute delirium
• Dementia
• Encephalitis, meningitis, or other infection
• Encephalopathy (particularly from liver or renal failure)
• Head trauma
• Hypoxia
• Intoxication or withdrawal
• Metabolic derangement (e.g. hyponatremia, hypocalcemia, hypoglycemia)
• Pain/Injury
• Seizure (post-ictal)

Question 24

What mental health conditions can cause behavioural disturbance?

Answer 24

• Psychotic disorders
• Mania
• Agitated depression
• Anxiety disorders
• Borderline and antisocial personality disorders

Question 25

What other conditions or situations can cause behavioural disturbance?

Answer 25

• Developmental issues
• Psychosocial adjustment
• Situational crisis
• Impulse control disorders
• Pain in patients with intellectual disability or cognitive impairment

Question 26

What are indicators of an organic cause of behavioural disturbance?

Answer 26

• First presentation/episode of acute behavioural disturbance in a person aged > 45 year
• Abnormal vital signs
• Focal neurological findings
• Decreased awareness of surroundings
• Difficulty paying attention
• Absence of a clear trigger or cause of the acute behavioural disturbance.

Question 27

What does the verbal de-escalation tool DEFUSE stand for?

Answer 27

Decide: Assess if verbal de-escalation is appropriate. Suitable candidates are responsive, engaged in conversation and not an active threat.
Ensure Safety: Have adequate backup, clear the area of potential weapons and maintain a safe distance (about two arms’ length).
Form Relationship: Introduce yourself, ask how they prefer to be addressed and seek permission to assist.
Utilise Interests: Acknowledge the patient’s feelings and agree as much as possible. Reassure that no harm will come to them.
Set Limits: Clearly outline the consequences of negative behaviour and provide choices.
Enforce/Evaluate: If aggression escalates, withdraw and call for assistance. After de-escalation, debrief everyone involved.

Question 28

What steps should be undertaking during the post procedural care for sedated Pts?

Answer 28

Continuously monitor vital signs (SpO2, EtCO2, NIBP, and ECG)and SAT score.
Document SAT and VSS every 5 minutes post each parenteral sedation for 20 minutes then 30 minutes for two hours or until transfer of care is complete.
Reassessment and management of organic causes of acute behavioural disturbance.
Monitoring should always be supplemented with vigilant clinical observation, as equipment alone may not detect all forms of clinical deterioration

Question 29

How should bariatric Pts be positioned post sedation?

Answer 29

Laterally, however if unable to then;

supine with ramping or head elevation

Question 30

What are the indications for the use of physical or mechanical restraints?

Answer 30

• The patient has a medical or psychiatric condition requiring care, and
• The patient is at the time incapable of responding to reasonable requests from clinicians to cooperate, and measures promoting self-control are impractical or have failed, and
• The patient’s behaviour is putting themselves or others at serious risk of harm, and
• Less restrictive alternatives are not appropriate

Question 31

When implementing restraint as an act of self-defence to defend oneself or another person during an assault which is likely to continue or to prevent a threatened and imminent assault. What should the clinician believe?

Answer 31

that it is necessary to defend him or herself or another person, or to protect property; and
is a reasonable response to the circumstances

Question 32

What are the physiological impacts of prone restraint?

Answer 32

a decrease in ventilation and / or cardiac output (CO) whilst in a prone restraint
Metabolic acidosis is noted with increased physical activity, in restraint associated cardiac arrest and simulated encounters
a decrease in ventilation and CO can significantly worsen acidosis and haemodynamics
Deaths associated with prone physical restraint are due to cardiac arrest secondary to metabolic acidosis compounded by inadequate ventilation and reduced CO

Question 33

A prone restrained patient who says ‘I can’t breathe’ is a potential warning sign for what?

Answer 33

imminent cardiovascular collapse

Question 34

How should a Pt with decreased LOC be positioned when in mechanical restraints?

Answer 34

• Laterally
• Attach the extension strap to one of the wrist cuffs and attach to the stretcher frame. If necessary reposition the other wrist cuff on the waist belt.

Note: Ensure that the person’s airway, breathing and circulation are not compromised. Once restrained all normal monitoring procedures must be maintained.
Stretcher harness must be used during transport in addition to the MRD.

Question 35

How should a pregnant Pt be positioned when in mechanical restraints?

Answer 35

• No waist belt
• Left lateral
• Attach the wrist extension strap to one of the wrist cuffs and attach it to the upper part of the stretcher frame. Attach the other wrist extension strap to the other wrist cuff and attach to the mid-section of the stretcher frame.

Note: Ensure that the person’s airway, breathing and circulation are not compromised. Once restrained all normal monitoring procedures must be maintained.