Psychiatric Emergencies Flashcards
One of the greatest potential errors in the Emergency Room in Psychiatry is:
Overlooking a physical illness as a cause of an emotional illness
T/F: having auditory disturbances of perception is one of the clues that point to a medical cause than a primary psychiatric condition
F
Having NON-auditory disturbances (tactile, smell)
T/F: having an acute onset of psych symptom is one of the clues that point to a medical cause than a primary psychiatric condition
T
T/F: having mental status signs is one of the clues that point to a medical cause than a primary psychiatric condition
T
examples are: seizures, loss of consciousness, head injury, gait, speech, movement disorders
The best predictors of violent behavior are:
Excessive alcohol intake
A history of violent acts, with arrests or criminal activity
History of child abuse
The root cause of aggression, violence and hostility is from the imbalance of _______ and _______
Impulse and control
The first task in evaluation of violent patients is to ascertain the ___ of violence
Cause
T/F: The cause of violence does not direct treatment
F
The cause will direct treatment
T/F: paranoid features in a psychotic patient is one of the signs of impending violence
T
T/F: Manic episodes can be a sign of impending violence
T
T/F: It is alright to talk to patients alone
F
Have others present, like the patient’s relatives or a mental health care professional
T/F: To prevent patient aggression, you can agree with the patient if they tell stories of their paranoia
F
but you can say, “I believe that YOU BELIEVE that…”
T/F: To calm a patient down who hears voices, you must talk to the voices that the patient is hearing
F
Do not talk to the voices
T/F: you should hide from the patient the fact that restraint will be used if necessary
F
Must inform patient
T/F: Don’t put your hands at the back because it makes the patient think you have medicines or restraints with you
T
T/F: Stay against the wall when interviewing a patient
F
Stay on the SIDE of the patient
T/F: Head must be slightly raised when restraining the patient
T
When patient gains control of him/herself, restraints may be removed one at a time every ___ minutes
5
How do you take out restraints one by one?
One hand > one foot > one hand > one foot
don’t take out the hands on both sides right away
Major indicators for chemical restraints
Violent or assaultive behavior
Massive anxiety or panic
Extrapyramidal reactions to antipsychotics
These antipsychotics are given for patients who are delusional or in a state of catatonic excitement requiring tranquilization
(drug, mg ampule dosage, route of administration)
Haloperidol, 5 mg ampules, IM
Chlorpromazine, 5mg ampule, IM
Olanzapine, 5mg, ORAL
Risperidone 2mg, oral solution or quicklet
This route of administration is done best if you cannot persuade the patient to take oral medicines
IM Injection
T/F: Benzodiazepines will NOT take away patient’s hallucinations and will only make them sleep
T
they will wake up and still be paranoid
When a recreational drug has strong anticholinergic properties, ________ drugs are more appropriate than antipsychotics
Benzodiazepines (Depressants)
The sleep produced by a relatively small amount of an IV benzodiazepine medication to a patient with furor caused by alcohol/ post-seizure psychomotor disturbance could last for ______.
T/F: On awakening, patients are often alert and rational, and has complete amnesia about the violent episode
Hours
T
Drugs given during extrapyramidal emergencies
(drug, mg dosage, route of administration)
Biperiden (akineton) 5mg amp, IM
Diphenhydramine (Benadryl), 50 mg IM
Drugs of choice for rapid tranquilization
(drug, mg dosage, route of administration)
Haloperidol, 5mg oral or IM
Olanzapine, 10 mg oral or IM
T/F: Goal to rapid tranquilization is to produce sedation and calm the patient down
F
NOT to produce sedation but to calm patient for them to cooperate in the assessment process
T/F: Intentional questioning is done in an interview with suicidal patients
Ex. Do you still feel like drinking the liquid to poison yourself?
T
T/F: Clinicians should always ask about suicidal ideas as part of MSE, especially if the patient is depressed
T
T/F: All suicidal patients are hospitalized
F
Not all suicidal patients are hospitalized
How do you assess the levels of intent and lethality of suicide?
Assess the:
Nature of the proposed method
Access to a proposed method
Presence of other persons who can prevent suicidal act or offer support
Suicide is considered (low/moderate/high) risk if there is serious consideration of harm, ideas of a plan and means, no access, the existence of some support, some risk factors present
Moderate risk
Suicide is considered (low/moderate/high) risk if there is details in the plan, the greater the degree of lethality and strength of risk factors and absence of support
High risk
Suicide is considered (low/moderate/high) risk if there is presence of ideation or passing thoughts without a plan and means
Low risk
T/F: When self injurious behavior occurred, hospitalization in a pediatric unit is required for treatment or injury or observation after toxic ingestion
T
T/F: Admission is indicated when patient has a persisting suicidal ideation and shows signs of psychosis, severe depression, or marked ambivalence about suicide
T
T/F: Young children who made suicide attempts that are of LOW risk require psychiatric admission
T
Risk of self harm if the patient with prior attempts has decided a method of doing so at a tentative time/place, with an easy access means, and have prepared some planning already.
MEDIUM
Risk of self-harm if the patient with no prior attempts has decided a method of doing so, with means already in possession and has steps taken to do it at a defined/chosen time or place.
HIGH
