Psychiatric Emergencies Flashcards
What % of psychiatric ER patients are suicidal
30%
What time of day do psychiatric emergency pt peak in attendance
6-10pm
E.g.s of major psych emergencies (2)
Suidical
Agitated or violent pt
E.g.s of minor psych emergencies (4)
Grief reaction
Rape
Disaster
Panic attacks
Medical ER in psychiatry (5)
Delirium NMS Serotonin syndrome OD common psych meds OD/withdrawal addiciting substances
`Delirium
Transient potentially reversible cerebral dysfunction that has an acute or subacute onset, which = manifested clinically by a wide range of fluctuating mental status abnormalities
WHat % of elderly pt in acute hospital admission have delirium
5 15
ICD 10 - Delirium
Clouding of consciousness Disturbed cognition w/ impaired immediate recall + recent memory Disorientation time place person At least 1 of: Variable activity levels Increased reaction time Altered flow of speech Enhanced startle reaction At least 1 other of: Insomnia Daytime drowsiness Reversal sleep-wake cycle Nocturnal worsening Sx Disturbing dreams/nightmares
Types of delirium (5)
Hyperactive delirium Hypoactive delirium Mixed delirium Delirium superimposed on dementia Persistent delirium
Delirium assessment
Take Hx/collateral Hx Consider physical causes for Physical exam + Ix Risk assessment AMT/MMSE
Ix delirium
Infection screen incl Culture/urinalysis, FBC, CRP, CXR Review meds Met/endocrine - U+E, LFT, Ca, gluc, TFT Cardiac - ECG, O2 Neuro - CT/MRI
Mx delirium
ID + Tx cause Provide calm info + supportive measures Involve family/carer Consider Rx to psych team Avoid sedation Review pt regu
Possible causes of delirium = I WATCH DEATH
Infection Withdrawal Acute metabolic causes Trauma CNS pathology Hypoxia Deficiencies Endocrinopathies Acute vascular Toxins/Dx Heavy metals
Causes - acute behavioural disturbances
Directly due to psychotic Sx e.g. delusion/hallucination
Non-psychotic Sx - high levels anxiety/arousal
Illicit substance use
Warning signs - acute behavioural disturbance (9)
Angry facial expression Restless/pacing Shouting Prolonged eye contact Refusal to cooperate Presence of delusions or hallucination w/ violent content Verbal threats/reports thoughts of voilence Blocking escape routes Evidence arousal
Methods of de-escalation - acute behavioural disturbance
Encourage pt to move into a safe space Speak confidently/slowly/clearly Adopt non-threatening body post - keep hands visible, slow movements, not too much eye contact Non-threatening verbral communication Pre-warn pt Explain concerns w/pt If poss - try to build rapport w/ pt If suspect weapons - make sure min no' people in room + request to put weapon in a neutral position
Aim of rapid tranq
calm agitated pt w/o sedating them and reduce risk of violence and harm
Which meds can be used as rapid tranqs (3)
Benzos
Antipsychotics
Promethazine
Which benzo = shortest onset + duration
Lorazepam
Midazolam - onset if given IM
15 mins
Midazolam - onset if given IV
3-5mins
Which antipsychotic is most commonly used as rapid tranq
haloperidol
NMS - RF (7)
Prev NMS Known cerebral compromise Alcoholism Agitated/catatonic mental state Those on IM therapy Recent antipsychotic dose increase High potency neuroleptic meds (haloperidol)
Sx NMS (5)
Fever Diaphoresis Rigidity Confusion Fluctuating consciousness
