Psychiatric Emergencies - Hill Flashcards
what are the most frequent disorders causing altered behavior?
- UTI’s
- pneumonia
- electrolyte disturbances
- endocrine disease
- MI
- strokes
- CNS mass lesions
NOTE: older adults (esp with dementia) are most vulnerable
what should NOT be given to elderly patients if aggravated/delirious?
adavan or lorazepam
- stick with haloperidol
what are the 3 values over 100 that may indicate withdrawal if they present together?
temp, HR, diastolic BP
what IV fluids should be given if withdrawal is suspected?
- *THIAMINE** and glucose - know this
- multivitamins
- folic acid
what medications can be given for withdrawal?
- lorazepam/adavan if known liver impairment
- diazepam
- chlordiazepoxide
thiamine, then benzo’s
what meds can be given is pt is violent?
- haloperidol
- lorazepam
- olanzapine
- ketamine
what labs should be run in violent pt?
- *urine drug screen**
- CBC
- BMP
CT scan of head
- also consult internal med, psychiatry, and neurology
what are the risk factors for a violent patient?
- previous attempts
- psychiatric diagnoses
- substance abuse
- lack of support
- medical conditions
- burden to family members
- impulsive/aggressive behavior
- local epidemics of suicide
what are the protective factors for a violent patient?
- effective clinical care for mental, physical and substance abuse
- easy access to a variety of clinical interventions and support for help seeking
- family and community support
- young children
- support from ongoing medical and mental care relationships
- skills in problem solving, conflict resolution, and nonviolent ways of handling disputes
- cultural and religious beliefs that discourage suicide and support instincts for self-preservation
when should you admit a suicidal patient?
- if risk factors outweigh protective factors
- affidavits of patient’s suicide attempts
- known diagnosis of psychiatric illness
- go with your gut
