Psych Flashcards
Initial Labs for psych pt
- CBC: infection, anemia
- CMP
- Urine drug screen
- UA
- Urine tricyclics: false + common
- EtOH
- Acetaminophen level
- Salicylate level
- Other med levels
Other initial tests for psych pt
- EKG: >60 yo, cardiac hx, OD suspected, tested + for cocaine, PCP, meth, tricyclics
- CXR: >60 or hypoxic
- CK: ensure not in rhabdo, acutely psychotic expend a lot of E
What is really important to get before police, EMS, family leave?
Third party statement
- gives reason to constrain, confine, EOD a pt against their will
EOD in OK
Emergency order of detention
- 72 hours
- not including weekends or holidays
- > 72 hr must get judge order
Management of acutely psychotic/agitated pt
- Safe evaluation of the pt
- remove dangerous items from room and self
- observe from distance first
- control own emotion/fear
- Enter room in non-threatening manner, keep 2-arm distance, don’t stare
- est rapport
- call for help if needed
Management of acutely psychotic/agitated pt
- desescalation
- Respect personal space: 2 arm lengths
- Don’t provocative: open hands, open body language
- Verbal contact: only one person talks to pt
- Concise: simple, repeat helpful info often
- ID needs, wants, feelings
- Actively listen to pt
- Agree or agree to disagree: “yes, but…” to avoid saying no all the time
- Lay down the law and set limits, coach pt how to stay in control
- Offer choices and optimism
Management of acutely psychotic/agitated pt
- Escalation failed :(
- warn pt that aggression will = restraints
- outnumber with staff
- have restraints ready (physical and chemical)
- monitor pt vitals and restraint sites
- Remove restraints as soon as possible
Types of restraints
- soft: MC, 4 point (wrists and ankles)
- leather: extreme violent/physicaly powerful pts
- reverse trendelenburg in bed
- one arm up, one arm down so they can’t “squirrel out”
Chemical sedation
- overview
- can help calm pt and keep staff safe
- unintended consequences: increased length of stay, ADR to meds
Chemical sedation
- 3 main options
- Benzos (Ativan): ADR - sedation, hypotension, resp. depression
- 1st Gen Antipsychotics (Haldol): ADR- sedation, Prolonged QT, extrapyramidal sx, neuroleptic malignant syndrome
- Atypical Antipsychotics (Zyprexa, Geodon): ADR - extrapyramidal sx, neuro malig syndrome, hypotension. Geodon: prolonged QT
Chemical sedation and special populations
- elderly: lower dose
- Seizure hx: antipsychotics lower seizure threshold… use benzos
- Peds/adolesecents: lower IM doses, use diff drugs
- Acute withdrawal: use benzos
Suicidal Ideation
- MC presentation
- Post a guard or sitter to keep safe, make sure nothing on them or in room they can use to harm themselves
- Evaluate threat, do they have a plan?
Suicide attempt
- first step
- figure out how:
- hanging, cut, GSW, OD, MVA
- teen-30 yo males most likely to complete suicide
OD
- pumping stomach not done
- call poison control, esp household products
- Insulin OD: ICU
- HTN meds, colchicine, insulin: dangerous
Manic behavior
- Most people with bipolar live nl life
- mania can be induced by stress: drugs/etoh, fam problems, med non-compliance
