Psychiatric Emergencies

Question 1

What are the 7 most frequent disorders causing altered behavior?

Answer 1

UTI, pneumonia, electrolyte disturbances, endocrine diseases, MI, strokes w motor deficits, CNS mass lesions, drug interactions, alcohol/med withdrawal

Question 2

What labs should be taken in a confusion/changes in behavior ER work up?

Answer 2

CBC, BMP, UA, glucose, ETOH and drug screen
CT head and CXR
EKG

Question 3

What is initial tx in a psych emergency?

Answer 3

Quiet room w quiet conversation, sedative agents like haloperidol w lorazepam for pt and staff protection (halo is best)

Question 4

What H and P is needed for alcohol withdrawal pt?

Answer 4

duration of drinking, when was last drink, hx of withdrawal seizures, hx of withdrawal hallucinations, previous rxn

Question 5

what is initial management of alcohol withdrawal?

Answer 5

IV fluids - thiamine and glucose to prevent wernike’s encephalopathy
Multivitamins, folic acid
Meds for withdrawal - lorazepam (if liver impairment), diazepam, chlordiazepoxide (w good liver fxn)

Question 6

Which psychiatric illnesses are at risk of violent behavior?

Answer 6

Schizo, personality disorders, mania, psychotic depression, psychotic pt w hx of incarceration due to violence, delirium, dementia

Question 7

How should you manage a pt w risk of violent behavior?

Answer 7

Verbal de-escalation, call security to physically restrain the pt

Question 8

What risk factors should be evaluated for a suicidal patient?

Answer 8

previous attempts and diagnoses, substance abuse, lack of support, medical condition, burden to family members, impulsive/aggressive tendencies, cultural and religious beliefs, local epidemics of suicide isolation

Question 9

What are protective factors found in suicidal patients?

Answer 9

Effective clinical care, easy access to clinical interventions, family and community support, young kids, support ongoing medical/mental health care relationship, skills in problem solving/conflict resolution, and nonviolent handling of disputes, cultural and religious beliefs that discourage suicide

Question 10

When do you admit a pt to psych unit?

Answer 10

Risks > protective
Affidavits of pt suicide attempt
Known diagnosis of psych illness
Go w gut feeling

Question 11

Initial work up for ETOH pt?

Answer 11

Labs - CBC (look at MCV and platelets), BMP, hepatic fxn, BAC, urine drug screen

Question 12

Initial workup for paranoid/violent pt?

Answer 12

Urine drug screen, CBC, BMP
CT scan of head
Consult IM, psych, neurology

Question 13

Which medications can be used to calm a violent patient?

Answer 13

HOLK - haloperidol, lorazepam, olanzapine, ketamine