Seizure, Suicide + Poisoning Flashcards
RF for szs
stroke, head injury, emotion, fever
Conditions that cause seizures
Febrile sz
Sleep deprivation
Hypoglycemia
Hyponatremia
CNS infection
Alcohol withdrawal
Substane use
Acute trauma
Management of actively szing pts
Ensure good airway control (OPA, lateral decubitus position)
Use benzos to stop seizure (IN midaz for peds or IV diazepam)
R/O metabolic cause (hypoglycaemia, hypoxia, heat stroke, electrolyte imbalance)
Counselling for szs
Triggers: sleep, diet, alcohol
Med adherence
Med interactions
Rescue meds
Driving
Safety
Women: avoid valproic acid, take 5mg folic acid, IUDs best contraception
Driving rules after sz
Single, unprovoked: no driving x3mo
After dx: can drive if no sz for 12mo + med compliant
Meds for generalised, absence + focal
Generalised: carbamazepine, lamotrigine, phenytoin
Absence: carbamazepine, lamotrigine, phenytoin
Focal: carbamazepine, phenytoin, levetiracetam
RF for suicide
Prev attempt
Older men
Hx of SH
Sexual minority
Fam hx of suicide
Legal problems
SUD
PTSD
PD
Cancer
Single
Hx of abuse
Management for low + high risk pts with SI
High risk - hospitalisation
Moderate/ low risk:
Contract for safety
Crisis planning
Treat underlying medical condition
Nonsuicidal self-injury (NSSI)
DSM V criteria
> 5 days past year
Expects NSSI will provide relief
Experiences negative thoughts before NSSI, preoccupation with NSSI or frequent thoughts of NSSI
NSSI linked to distress
What is involved in a Crisis plan?
Provide specific instructions for FU
Develop plan if sx worsen, inc signs of crisis
Self-management skills (distraction, stress relief)
Identify social and community resources
Discuss protective factors
Reduce access to lethal means
Gastric lavage when?
less than 2 hrs ago, potentially lethal, no antidote available
What to give in an unconscious patient
dextrose, oxygen, narcan, thiamine
BB antidote
glucagon
Iron antidote
desferoxamine
Bradycardic pt rx
atropine