psych emergencies

Question 1

Delirium tremens

Answer 1

typically 2-4 days after cessation of EtOH
delirium, agitation, fever, autonomic hyperactivity, Auditory/visual hallucinations

treat aggressively with BZDs and hydration

Question 2

Neuroleptic malignant syndrome

Answer 2

fever, rigidity, autonomic instability, clouding of consciousness, elevated WBC/CPK

withhold neuroleptics, hydrate, consider dantrolene +/- bromocriptine

Question 3

serotonin syndrome

Answer 3

precipitated by use of 2+ drugs with serotonin enhancing properties (MAOI + SSRI)

AMS, fever, agitation, tremor, myoclonus, hyperreflexia, ataxia, incoordination, diaphoresis, shivering, diarrhea

d/c offending agent and give BZD and maybe cyproheptidine

Question 4

tyramine reaction / HTN crisis

Answer 4

precip by ingestion of tyramine containing foods while on MAOIs
HTN, HA, neck stiffness, sweating, n/v, visual problems, stroke and death
treat with nitroprusside or phentolamine

Question 5

acute dystonia

Answer 5

early sudden onset of muscle spasm: eyes, tongue, jaw, neck, may lead to laryngospasm requiring intubation
treat with benztropine (cogentin) or benedryl

Question 6

Lithium toxicity

Answer 6

may occur at any Li level ucu > 1.5
n/v, slurred speech, ataxia, incoordination, myoclonus, hyerreflexia, seizures, nephrogenic diabetes insipitus, delirium, coma
d/c LI, hydration, hemodialysis

Question 7

TCA toxicity

Answer 7

anticholinergic effects: cardiac conduction disturbances, HoTN, resp depression, agitation, hallucinations
CNS stimulation, depression, seizures

EKG, charcoal, carthatics, supportive tx