Psychiatric Emergencies (Hill)

Question 1

most frequent disorders causing altered mental status (7)

Answer 1

• UTI
• pneumonia
• electrolyte disturbances
• endocrine diseases: thyroid
• myocardial infarction
• strokes w/o motor deficits
• CNS mass lesion

Question 2

population most vulnerable to mental status changes

Answer 2

older adults, especially those with dementia

Question 3

common cause of AMS in older adults

Answer 3

medication adverse effects and drug interactions

Question 4

ER workup for AMS

Answer 4

• vitals (O2)
• PE (neuro deficits)
• Labs (CBC/BMP/UA/glucose/EtOH/drug screen)
• radiology (CT head and CXR)
• EKG

Question 5

first and second things to check for with AMS

Answer 5

1) oxygen levels

2) fever or signs of infection

Question 6

initial treatment AMS (4)

Answer 6

• keep patient/staff SAFE
• environmental manipulation (quiet room/calm conversation)
• sedative agents such as haloperidol or lorazepam
• treat lab results

Question 7

What sedative agent should NOT be used in older patients?

Answer 7

lorazepam… makes agitation and confusion worse

Question 8

Initial questions acute EtOH intoxication (5)

Answer 8

• how long has patient been drinking
• when was the last drink
• h/o withdrawal seizures
• h/o withdrawal hallucinations
• previous treatments

Question 9

important vitals acute EtOH intoxication (2)

Answer 9

• elevated blood pressure

- elevated heart rate

Question 10

important labs acute EtOH intoxication (5)

Answer 10

• CBC (MCV, platelets)
• BMP (hyponatremia)
• hepatic function
• blood EtOH level
• urine drug screen

Question 11

important IV fluids EtOH intoxication (3)

Answer 11

• thiamine and glucose (prevent Wernicke’s encephalopathy)
• multivitamins
• folic acid

Question 12

medication for EtOH withdrawal used if there is known liver impairment

Answer 12

Lorazepam

Question 13

what is a risk factor for violent behavior in the emergency department?

Answer 13

known psychiatric illness

Question 14

medications for violent behavior (4)

Answer 14

1) haloperidol
2) lorazepam
3) olanzapine
4) ketamine

Question 15

additional history for violent behavior (3)

Answer 15

1) previous episodes
2) family history
3) drug and EtOH use

Question 16

labs for violent behavior (3)

Answer 16

1) urine drug screen
2) CBC
3) BMP

Question 17

radiology for violent behavior

Answer 17

CT scan of head

Question 18

consults for violent behavior (3)

Answer 18

1) IM
2) psychiatry
3) neurology

Question 19

evaluation for suicidal patient (4)

Answer 19

1) be calm, non-threatening, and non-judgmental
2) evaluate for risk factors
3) barriers to accessing mental health treatment
4) protective factors

Question 20

When to admit suicidal patient to inpatient psychiatric unit (4)

Answer 20

1) risk factors outweigh protective factors
2) affidavits of patient’s suicide attempt (involuntary admit)
3) known diagnosis of psychiatric illness
4) go with “gut” feeling