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PAR2032 - Mental Health > Week 5 > Flashcards

Week 5 Flashcards

1
Q

What is the presentation of Ketamine?

A

200mg in 2mL

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2
Q

What is the treatment for a patient who falls under the mild/moderate agitation category?

A

Midazolam 5 - 10mg IM
repeat @10mins
Max dose 20mg

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3
Q

What are some potential differential diagnosis of excited delirium?

A 
serotonin syndrome
sympathomimetic syndrome
diabeteic hypoglycaemia
drug withdrawal
heat stroke
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4
Q

When should sedation be administered for HYPERTHERMIC psychostimulant overdose?

A

administered early to help with cooling

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5
Q

What is Instrumental aggression?

A

Premeditated ‘COLD’ goal directed

More proactive

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6
Q

what are some psychiatric causes of excited delirium?

A

acute psychosis
mania
schizophrenia

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7
Q

WHat are the side effects of midaz?

A

depressed level of consciousness
resp depression
loss of airway control
hypotension

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8
Q

what is the peak time of midaz IM?

A

15 mins

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9
Q

In all cases where sedation is administered, supportive care should be provided as required, this includes what?

A
  • airway management
  • supplmentary O2 if sedated with midaz of ket
  • perfusion management
  • temperature management
  • management of causes of agitation
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10
Q

what factors contribute to aggression?

A 
hypoglycaemia
psychiatric illness
substance abuse
head injury
hypoxia
metabolic imbalances
frustration
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11
Q

What is the pharmacology of ketamine?

A

a rapid acting dissociative anaesthetic agent

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12
Q

What does cocaine do to affect dopamine levels?

A

chronic use leads to dopamine depletion, affecting dopaminergic balance, leading to:

  • cardiac hypertrophy
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13
Q

What is the pathophysiology of excited delirium?

A

Dopamine hypothesis:

depletion of dopamine levels fucks with them basically.

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14
Q

What are the contras for ketamine?

A

hypersensitivity

sever hypertension >180

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15
Q

When should you consult before administering sedatives?

A

if GCS 10-14

or if outside guidelines

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16
Q

What is the treatment for a patient who falls under the extreme agitation category?

A

Ketamine IM
<60kg = 200mg
60-90kg = 300mg
>60kg = 400mg

If Ket unavailable:
Midazolma 20mgIM
Repeat @10min
Max 40mg

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17
Q

What is the onset time of ket IM?

A

3-4 mins

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18
Q

What are bath salts?

A

synthetic cathinones

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19
Q

What are the risks of chemical restraint?

A

decreased level of consciousness
resp depression
asphyxiation
hypotension

20
Q

what are some metabolic/endocrine causes of excited delirium?

A 
electrolyte imbalances
hypoxia
hyperglycaemia
hypoglycaemia
uremia
thyrotoxicosis
21
Q

what are some toxicological causes of excited delirium?

A

alcohol
amphetamines
cocaine

22
Q

What is the presentation of midazolam?

A

5mg in 1mL

23
Q

What are the elements of excited delerium?

A 
bizzare/aggressive behaviour
dilated pupils
fear and panic
hyperthermia
incoherent speech
tachypnoea
nakedness
profuse sweating
shivering
increased pain tolerance
unusual strength
mirror/glass attraction
24
Q

What is the duration of ket IM?

A

12-25 mins

25
Q

What are the 5 steps in behavioural assessment for hostile aggression?

A
  1. minor movements (clenching fists)
  2. verbal abuse and threats
  3. major motor movements (pacing)
  4. aggression
  5. exhaustion
26
Q

How do bath salts work?

A

synthetic cathinones target monamine transporters:

they disrupt the function of monoamine transporter proteins expressed on neurons in the central and peripheral NS

27
Q

What are the potential clinical caused for agitation to considers as per AV CPG’s?

A 
AIEOUTIPS
A- alcohol/drugs
E - epilepsy
I - Insulin or other metabolic cause
O - overdose/oxygen
U - underdose
T - Trauma
I - Infection/sepsis
P - Pain/psychiatric
S - stroke / TIA
28
Q

How do you differentiate excited delirium syndrome (ExDS) from sympathomimetic syndrome?

A

more likely to dislpay bizarre abnormal behaviour with non-toxic amount of recent drug use

such as walking through traffic/being naked in public etc

29
Q

What are the side effects of ketamine?

A

increase BP and HR

Resp depression
emergence reactions
enhanced skeletal tone
nausea and vomiting

Diplopia
Nystagmus

Lacrimation
Salivation

30
Q

What is the onset time of midaz IM

A

3-5mins

31
Q

What is the duration if midaz IM?

A

30 minutes

32
Q

what is the pharmacology of midaxzolam?

A

short acting CNS depressant

33
Q

What are the risk factors for aggression and violence?

A 
Past history of aggression
Male
Youth
Anti-social traits
Substance misuse
Intoxication
Impulsivity
Irritability
Suspiciousness
Mental Illness
34
Q

What is the treatment for an elderly/frail patient who falls under the mild/moderate agitation category?

A

Midazolam 2.5 - 5mg IM
repeat @10mins
Max dose 20mg

35
Q

What is the preferred site for IM administration?

A

antereo-lateral mid thigh

36
Q

What are some of the more potential signs of aggression?

A 
under influence
slurred speech
sarcastic and abusive
intruding on personal space
hostile facial expressions
blood stained clothes
possession of a weapon
obvious motor restlessness
37
Q

what are some neurogenic causes of excited delirium?

A

dementia
head injury
seizure
post-ictal state

38
Q

what is aggression?

A

any offensive action, attach, or procedure or encroachment upons ones rights

Psychiatric definition: overt or suppressed hostility, either innate or resulting from continued frustration and directed outwards

39
Q

What is hostile aggression

A

im[ulsive ‘HOT’ unplanned and driven by anger

reactive

40
Q

What are two types of aggression?

A

Hostile aggression

Instrumental aggression

41
Q

What are the contraindications of midazolam?

A

hypersensitivity to benzodiazepines

42
Q

What other causes of agitation should you consider apart from AIEOUTIPS?

A

extreme grief

43
Q

What is the target therapeutic dose of ketamine for patients affected my methamphetamines and classed under extereme agitation?

A

4mg/kg IM or 1mg/kg IV

44
Q

what are some signals of agitation?

A 
restlessness/fidgeting
may try to remove IV or O2
no intent to injure
may fight against interventions
appear anxious
45
Q

Define agitation?

A

the act or process of agitating, state of being agitated

it is an unpleasant state of extreme arousal, increased tension, irritability, restless or anxious

46
Q

what are some causes of agitation?

A 
Drugs/alcohol
Head injury
Intyracerebral pathology (eg dementia)
Hypoglycaemia
Hypoxia
Post-ictal
Extreme emotion, stress
Psychiatric condition
Pain or discomfort
Delirium
47
Q

What is the dose for ketamine administration in extreme agitation?

A

Ketamine IM
<60kg = 200mg
60-90kg = 300mg
>60kg = 400mg

PAR2032 - Mental Health (12 decks)

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