Psych Emergencies Flashcards
1
Q
What are factors assoc w/ pt violence?
A
- male
- hx of violence
- drug or alcohol abuse
2
Q
Signs of impending violence?
A
- provocative behaviro
- angry demeanor
- loud, aggressive speech
- tense posturing
- frequently changing body position
- aggressive acts
3
Q
Dxs assoc w/ violence? (FIND ME)
A
- Fxnl: psych (schizophrenia, paranoid, cataonic, mania) miscommunication (fear of rejection, dependecy, illness)
- Infectious: CNS, meningiits, encephalitis, sepsis
- Neuro: head injury/hemorrhage, postictal states, vasculitis, neoplasm
- Drug related: alcohol, amphetamines, PCP, LSD, steroids
- Metabolic: lyte abnorm, hypothermia/hyperthermia/ anemia, vit def (B, folate), wernicke’s encephalopathy, hypoxia
- Endocrine: hypoglycemia, thyroid storm, cushing’s disease
4
Q
Management of a violent pt? (verbal techniques)?
A
- remove pt from contact w/ provocative pts
- expedite eval
- verbal techniques: address violence directly, set limits, don’t be provocative, be honest and straightforward, calm and soothing tone of voice, simple language, offer choices and optimism, stand at least 1 arm’s length away, ID feelings and desires, take all threats, seriously, and protect yourself
5
Q
Indications for physical restraints?
A
- if verbal techniques are not working and escalation occurs - get help!
- use of restraints can be humane and effective, can help w/ dx and tx, remove ASAP, usually when chemical restraint is achieved
- indications:
imminent harm to others, to self, sig disruption of impt tx or damage to enviro - continuation of effective, ongoing behavior tx plan
- should have 5 person restraint team, if female pt - one member must be female
- once pt is restrained needs to be monitored closely: position, resp, avoid aspiration
- documentation is rqd
6
Q
3 classes of meds use as chemical restraints?
A
- benzos
- 1st gen antipsychotics: haldol
- 2nd gen: resperdol, seroquel
7
Q
When are benzos preferred as the chemical restraint?
A
- when sedating pts when agitated from unknown cause
- lorazepam and midazolam (shorter half life): both PO, IM, IV
- can cause resp depresssion: monitor closely!!
- can be used w/ first gen antipsychotic
8
Q
1st gen antipsychotics used as chemical restraint? When should you avoid these?
A
- haloperidal (PO, IM)
- droperidol (IM, IV) - BBW prolong QT
- both cause QT prolong w/ potential causing dysrthymias (torsades)
- avoid:
cases of EToH withdrawal
benzo withdrawal
other w/drawals
anticholinergic toxicity
pts w/ seizures
pregnant and lactating females
9
Q
2nd gen antipsychotics used as chemic restraints?
A
- olanzapine (zyprexa)
- risperidone (risperdal)
- ziprasidone (Geodon)
- less sedation and fewer extrapyramidal side effects
- less experience using them so benzos and 1st gen antipsychotics first choice
10
Q
For severely violent pts reqring immediate sedation - what should be given?
A
- 1st gen or /+ benzo
11
Q
For pts w/ agitation from drug intoxication - what should be given?
A
- benzo
12
Q
For pts w/ undiff agitation what should be given?
A
- benzos preferred but 1st gen AP can be used
13
Q
For agitated pts w/ known psych disorder what should be given?
A
- 1st or 2nd gen AP
14
Q
What should be included in post-restraint medical eval?
A
- complete set of VS including pulse ox
- thorough mental status and neuro exams
- rapid blood glucose determination
- r/o acute medical condition (brain bleed for ex)
15
Q
Presentation of AIDS encephalopathy? MC etiologies?
A
- presentation: change in mental status, abnorm neuro exam
- must determine degree of immunosuppression
- MC etiologies:
toxoplasmosis encephalitis
primary CNS lymphoma
progressive multifocal leukoencephalopathy, HIV encephalopathy, CMV encephalitis
16
Q
What is psychosis?
A
- disturbance in perception of reality, evidenced by hallucinations, delusions, or though disorganization. Psychotic states are periods of high risk for agitation, aggression, impulsivity and other forms of behavioral dysfxn
17
Q
Psychosis occurs in what disorders?
A
- schizophrenia
- bipolar mania
- major depression w/ psych features
- schizoaffective disorder (depression or mania occurs and then psychosis occurs at sep time)
- alzheimers
- delirium
- substance induced psychotic disorder
- psychosis secondary to medical condition
18
Q
Eval of pt presenting w/ psychosis?
A
- MSE: mini mental, observation of pt - med eval: VS (including pulse ox) PE chem panel CBC thyroid fxns UA drug screen add testing as indicated
19
Q
What are the adverse effects of cocaine use?
A
- anxiety/irritability
- panic attacks
- suspiciousness/paranoia
- grandiosity/impaired judgement
- psychotic sxs: delusions/hallucinations
- physical sx due to SNS stim:
tachycardia, tachypnea, HTN, hyperthermic, diaphoretic, dilated pupils
20
Q
Withdrawal sxs of cocaine?
A
- prominent psych features: depression, anxiety, fatigue, difficulty concentrating, craving cocaine, increased sleep, increased appetite
- physical sxs: minor and rarely reqr tx, arthralgias, tremor, chills
21
Q
Tx of cocaine withdrawal?
A
- mainly supportive
- allow pt to sleep and eat as needed
- no meds shown to help
- hosp mainly for psych sxs
- determining d/c: psych eval for tx addiction, usually tx as outpt, so if cleared medically and by psych can be d/c
22
Q
S/S of overdose/intoxication of meth?
A
- tremor
- muscle twitch
- tachypnea
- tachycardia
- hallucinations
- aggressive behavior
- sweating, convulsions
- panic
- agitated
23
Q
Meth is assoc w/ why psych sxs? Dx?
A
- paranoia, psychosis, and delusions
- homicidality and suicidality
- mood disturbances
- anxiety and hallucinations
- dx: sympathomimetic toxidrome, diff it from cocaine and PCP
24
Q
Eval of meth intoxication? Labs?
A
- complications: hypovolemia, metabolic acidosis, hyperthermia, and rhabdo
- check:
lytes
lactaet
CK
aminotraferases
clotting times
renal fxn
ABG s
25
Q
Tx of meth intoxication?
A
- control agitation w/ benzos or w/ 2nd Gen AP
- physical restraints are undesirable
- succinylcholine is CI
- control hyperthermia, fluid resuscitation
- HTN: tx w/ nitroprusside or phentolamine, avoid BBs
- use of activaed charcoal is rarely indicated
