Psychiatric Emergencies

Question 1

What patients are most vulnerable to having altered behavior?

Answer 1

Older adults, particularly those with dementia.

Question 2

Which sedative agents can be given in a psychiatric emergency for patient and staff protection? (3)

Answer 2

**Haloperidol (Haldol): 2-5 mg IM every 15-30 min until agitation controlled.

Lorazepam - do NOT give to older patients!

Olanzapine: 2.5-5 mg IM every 3 hrs.

Question 3

What 3 medications can be used to treat withdrawal?

Answer 3

*Lorazepam - use if known liver transplant

Diazepam

Chlordiazepoxide

Question 4

Which IV fluids can be given if a patient is intoxicated?

Answer 4

Thiamine and glucose - prevents Wernicke’s encephalopathy

Multivitamins

Folic acid

Question 5

If a patient has abnormal mental status testing and an abnormal attention span in the ED, what should you think?

If they do NOT, what should you think?

Answer 5

+ confusion, delirium

• thought disorder, psychiatric disorder

Question 6

Which labs should be ordered in a patient that is intoxicated in the ED? (5)

Which vitals are of particular concern?

Answer 6

CBC - look at MCV and platelets
Basic metabolic panel - hyponatremia
Hepatic function
Blood EtOH
Urine drug screen

BP and pulse might be elevated (signs of withdrawal)

Question 7

Which disorders frequently present with mental status changes?

Answer 7

UTIs

Pneumonias

Electrolyte disturbances

Endocrine diseases - thyroid disease

MI

Strokes

CNS mass lesions

Question 8

Which patient type should NOT be given Lorazepam?

Answer 8

Older patients - will worsen delirium!