Psych Flashcards
repeat ED users
Schizophrenia pts
Components of a mental status exam in the ED
Behavior, Affect, Orientation, Language, Memory, Thought content, Perceptual abnormalities, Judgement
basic lab studies for a suspected psych pt that can help r/o other organic disease
CBC, Chem 7, LFT’s, EKG, CXR, Tox studies, +/- CSF and CT
Lab studies required for a psych pt
if the pt is stable, and the complaint is primarily psych, evaluation should be focused on the history and PE, not on lab results. If pt is Alert and cooperative, do not even need to order tox screen- is NOT recommended.
antipsychotic drug of choice in the ED
Haldol. beware- can cause dystonia
Antipsychotic dosing in the ED
Haldol 5 mg IV q 15 mins until agitation is controlled. Can start with 2 mg IV and double the dose every 45 mins until controlled, but this is off label use.
If there is not an IV in place can give IM haldol 2-5 mg q1hr.
amount of antipsychotic to not exceed in ED
Do not exceed 20 mg haldol/day
antipsychotic additive that can be used to more rapidly control agitation
Can add lorazepam (ativan), which works synergistically with Haldol. 1-2 mg IV or IM
when pt displays violent behaviour
that demands an immediate restraint in the ED
Number of people necessary for applying physical restrains
6- one for each limb, one for the head and one to actually apply apply the restraint
contraindications for 4 point restraint
pt is competent and refusing care, pt is not a danger to self or others, or when less restrictive alternatives have not been attempted
removing restraints
should not be done all at once- go from 4–> 2–> 1
continuing restraints
they need to be ordered and reordered every 4 hours with documented reasoning for restraints
involuntary psych hold
if the provider has reasonable belief that the pt is at immediate risk of harm to self or others and the pt is not consenting to treatment, the pt can be held against their will in the ED for at least 12 hours, a maximum of 72 hours to allow for psych evaluation and treatment to commence
Documentation of physical abuse in the ED
when possible, take pictures of the injuries presented to the ED. One should include the pt’s face. include reference object (like a ruler) for size. Be sure to have consent for this.
