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CP2 Psychiatry > Psychiatric Emergencies > Flashcards

Psychiatric Emergencies Flashcards

1
Q

What % of psychiatric ER patients are suicidal

A

30%

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2
Q

What time of day do psychiatric emergency pt peak in attendance

A

6-10pm

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3
Q

E.g.s of major psych emergencies (2)

A

Suidical

Agitated or violent pt

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4
Q

E.g.s of minor psych emergencies (4)

A

Grief reaction
Rape
Disaster
Panic attacks

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5
Q

Medical ER in psychiatry (5)

A 
Delirium
NMS 
Serotonin syndrome 
OD common psych meds
OD/withdrawal addiciting substances
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6
Q

`Delirium

A

Transient potentially reversible cerebral dysfunction that has an acute or subacute onset, which = manifested clinically by a wide range of fluctuating mental status abnormalities

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7
Q

WHat % of elderly pt in acute hospital admission have delirium

A

5 15

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8
Q

ICD 10 - Delirium

A 
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
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9
Q

Types of delirium (5)

A 
Hyperactive delirium 
Hypoactive delirium 
Mixed delirium 
Delirium superimposed on dementia 
Persistent delirium
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10
Q

Delirium assessment

A 
Take Hx/collateral Hx 
Consider physical causes for 
Physical exam + Ix 
Risk assessment 
AMT/MMSE
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11
Q

Ix delirium

A 
Infection screen incl Culture/urinalysis, FBC, CRP, CXR
Review meds
Met/endocrine - U+E, LFT, Ca, gluc, TFT
Cardiac - ECG, O2
Neuro - CT/MRI
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12
Q

Mx delirium

A 
ID  + Tx cause
Provide calm info + supportive measures 
Involve family/carer 
Consider Rx to psych team 
Avoid sedation
Review pt regu
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13
Q

Possible causes of delirium = I WATCH DEATH

A 
Infection 
Withdrawal 
Acute metabolic causes 
Trauma 
CNS pathology 
Hypoxia
Deficiencies 
Endocrinopathies 
Acute vascular 
Toxins/Dx 
Heavy metals
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14
Q

Causes - acute behavioural disturbances

A

Directly due to psychotic Sx e.g. delusion/hallucination
Non-psychotic Sx - high levels anxiety/arousal
Illicit substance use

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15
Q

Warning signs - acute behavioural disturbance (9)

A 
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
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16
Q

Methods of de-escalation - acute behavioural disturbance

A 
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
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17
Q

Aim of rapid tranq

A

calm agitated pt w/o sedating them and reduce risk of violence and harm

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18
Q

Which meds can be used as rapid tranqs (3)

A

Benzos
Antipsychotics
Promethazine

19
Q

Which benzo = shortest onset + duration

A

Lorazepam

20
Q

Midazolam - onset if given IM

A

15 mins

21
Q

Midazolam - onset if given IV

A

3-5mins

22
Q

Which antipsychotic is most commonly used as rapid tranq

A

haloperidol

23
Q

NMS - RF (7)

A 
Prev NMS 
Known cerebral compromise 
Alcoholism 
Agitated/catatonic mental state
Those on IM therapy 
Recent antipsychotic dose increase
High potency neuroleptic meds (haloperidol)
24
Q

Sx NMS (5)

A 
Fever
Diaphoresis 
Rigidity 
Confusion 
Fluctuating consciousness
25
Q

Ix NMS (3)

A

CK - raised
Leucocytosis
Deranged LFTs

26
Q

Tx NMS (5)

A 
Withdraw antiP meds
Monitor T BP pulse
Consider benzos
Rehydration 
DA agonist - bromocriptine/dantrolene
27
Q

What is Acute dystonia

A

Reversible extrapyramidal SE after the admin of antipsychotic meds

28
Q

When is acute dystonia life threatening?

A

If involving laryngeal mm

29
Q

Which brain pathway is thought to be involved in acute dystonia

A

D2 receptor blockage in the nigrostriatal pathway

30
Q

Prevalence acute dystonia

A

10%

31
Q

Who is acute dystonia more common in? (3)

A

Young men
Those = neuroleptic naive
on high potency D2R meds - haloperidol

32
Q

Sx acute dystonia

A 
Dystonia 
Torticollis 
Tongue dystonia 
Jaw dystonia 
Oculogyric crisis 
Sx onset either immediately or delayed for a few hrs-days
33
Q

Tx acute dystonia

A

Procyclidine 5-10mg PO/IM/IV

Check for cyanosis + admin O2 + transfer to med unit prn

34
Q

Which organ is Lithium excreted by?

A

Kidneys

35
Q

Early Sx Lithium toxicity(6)

A 
Marked tremor 
Anorexia 
N+V
Diarrhea 
Dehydration + lethargy
36
Q

Later Sx Lithium toxicity (10)

A 
Restlessness 
Mm fasciculations 
Myoclonic jerks
Choreo-athetoid movements 
Marked hypertonicity 
==> 
Ataxia
Confusion 
HoTN
Seizures
Coma
37
Q

Tx Lithium toxicity

A

Immediate stop Li
Maintain adequate hydration
If severe –> haemodylaisis

38
Q

Causes of serotonin syndrome

A

When pt is being switched from 1 antiD to another

In combo w/ triptans, herbal substances (St Johns), illegal substances

39
Q

Sx serotonin syndrome

A 
Restlessness 
Confusion 
Agitation 
Hyperthermia 
GI upset
TachyC
Hypo/hypertension 
Mydriasis 
Myoclonus
Rigidity 
Tremors 
Hyperreflexia 
Ataxia 
Convulsions
40
Q

Tx serotonin syndrome

A

Stop meds
rehydrate
Benzos - tx agitation
Transfer to ED

41
Q

NMS vs Serotonin syndrome - onset

A

Slow (days to weeks) - NMS

Rapid - S S

42
Q

NMS vs serotonin syndrome - progression

A

Slow (24-72h) - NMS

Rapid - S. S

43
Q

NMS vs Serotonin syndrome - mm ridigity

A

NMS - severe (lead pipe)

S S - < severe

44
Q

NMS vs Serotonin syndrome - activity

A

NMS - bradykinesia

S. S - hyperkinesia

CP2 Psychiatry (15 decks)

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