behavioral emergencies - I.ppt
- 2. 2 Behavioral Emergencies • Person exhibits “abnormal” behavior • Threat to self, family, or community • Patient may display – Panic – Agitation – Bizarre thinking or actions
- 3. 3 Common Causes of Behavioral Change • Situational stresses • Medical illness • Psychiatric problems • Alcohol • Drugs
- 4. 4 Common Reasons • Low blood sugar (diabetic) • Hypoxia • Inadequate blood flow to the brain • Head trauma • Mind-altering substances • Psychogenic substances • Excessive cold or heat • Infections of the brain or its coverings
- 5. 5 Physical vs. Emotional • Sudden onset of symptoms, behavioral develops more gradually • Memory loss or impairment, most behavioral the memory remains intact • Dilated, constricted, or unequal pupils • Excessive salivation • Incontinence • Unusual odors on breath
- 7. 7 Anxiety • State of painful uneasiness about impending problems • Hyperventilation causes – Dizziness – Tingling around mouth and fingers – Carpal-pedal spasms – Tremors – Irregular heartbeat – Palpitations – Diarrhea – Sob, choking, smothering – Severe cases, sudden cardiac arrest
- 8. 8 Phobias • Fear of specific things, places, or situations • Show intense fear • Tremors • Tachycardia • Irregular heartbeat • Dyspnea • Sweating • Diarrhea
- 9. 9 Depression • Most common psychiatric condition • Feeling of sadness, worthlessness, discouragement. • Factor in approximately 50% of suicides • Crying spells, listless or apathetic behavior • Feel helpless, hopeless, withdrawn, pessimistic • Suffer appetite loss, sleeplessness, fatigue, despondence, and severe restlessness
- 10. 10 Bipolar Disorder • Manic-depressive disorder • Moods alternate from a normal state to a depressive one • Mood changes can last for months or change rapidly within a few hours
- 11. 11 Paranoia • Highly exaggerated or unwarranted mistrust or suspiciousness • Often hostile & uncooperative • “Someone is out to get them” • Cannot accept fault or blame • They seem cold, aloof, hypersensitive, defensive • Excitable and unpredictable • Outburst of bizarre or aggressive behavior
- 12. 12 Schizophrenia • Name given to a group of mental disorders • Suffer debilitating distortions of speech and thought • Bizarre delusions, hallucinations, social withdrawal, and lack of emotional expressiveness • Rarely manifested as multiple-personality disorder
- 13. 13 Violence
- 14. 14 Suicide • Men more successful, more violently done • Women make three times as many attempts • Often dismissed as “just trying to get attention” • 1st attempt unsuccessful, 2nd attempt usually successful if not helped • Every suicidal act or gesture should be taken seriously, and the patient should be transported for evaluation
- 15. 15 4 Most Common Methods • Self-inflicted gunshot wound • Hanging • Poisoning by ingestion • Carbon monoxide poisoning
- 16. 16 Most Likely Candidates • 70% men over 40, single, widowed, or divorced • History of alcoholism or drug use • Severe depression • Previous suicide attempts • Formulated highly lethal plan • Gathering of articles used for suicide attempt • Self-destructive behavior • Serious illness • Recent loss of a loved one • Arrest, imprisonment, loss of job
- 17. 17 Early Signs of Violence • 60 to 75% become violent • Nervous pacing • Shouting • Threatening • Cursing • Throwing objects • Clenched teeth and or fists
- 18. 18 Basic Principles for Behavioral Emergencies • Every person has limitations • Each person has a right to his feelings • Each person has more ability to cope with crisis than he might think • Everyone feels some emotional disturbance when involved in a disaster or when injured • Emotional injury is just as real as physical injury • People who have been through a crisis do not just “get better” • Cultural differences have a special meaning when you are called to intervene in a behavioral emergency
- 19. 19 Techniques for Treatment • Speak in calm, reassuring voice directly to patient • Maintain a comfortable distance • Seek the patient’s cooperation • Maintain good eye contact • Do not make any quick movements • Respond honestly to questions, don’t foster unrealistic expectations • Never threaten, challenge, belittle, or argue with patient
- 20. 20 Techniques for Treatment Cont.. • Always tell the truth • Don’t play along with visual or auditory disturbances • Involve trusted family members and friends • Be prepared to be on scene a long time • Never leave the patient alone • Avoid use of restraints • Do not force the patient to make decisions
- 21. 21 Techniques for Treatment Cont.. • Encourage patient to participate in a motor activity which helps reduce anxiety • If the patient has attracted a crowd, try to disperse it and deal with the patient on a one-to-one basis
- 22. 22 Assessment
- 23. 23 Scene Size-Up • Make sure the scene is safe • Stage until police arrive • Ask for weapon, If patient does not, back out until police arrive • If in doubt call police • Determine number of patients – Suicide pacts
- 24. 24 Suicidal Patient Assessment • Related injuries or medical conditions primary concern • Listen carefully • Accept all patient’s complaints and feelings • Do not trust “rapid recoveries” • Be specific in your actions • Never show disgust or horror, Watch your body language • Don’t deny that suicide attempt occurred • Never try to shock the patient out of suicide attempt
- 25. 25 Violent Patient Assessment • Take history • Observe patient’s posture • Listen to patient • Monitor the patient’s physical activity • Be firm and clear • Be prepared to use restraints
- 26. 26 Emergency Care • Your safety comes first • Assess patient for trauma or medical condition • Calm and stay with patient • If necessary to protect yourself or others, use restraints • Transport to appropriate facility
- 27. 27 Restraining A patient • Use humane restraints • Contact med-control or follow protocol • Have enough people to do the job • Plan activity before acting • Use only as much force as necessary • Estimate range of motion • Act quickly • Talk to patient throughout process • Secure to stretcher • If patient spits cover his face with mask • Do not remove restraints
- 28. 28 Refusal of Care • If patient threatens to hurt himself or others and you can demonstrate reason to believe that the patient’s threats are real, you can transport the patient without consent. • Have law enforcement personnel participate in the transport of the patient.
- 29. 29 Reasonable Force to Restraint • Size and strength of patient • Type of behavior exhibited by patient • Mental state of patient • Method of restraints – Soft restraints are reasonable – Metal cuffs are not
- 30. 30 False Accusations • Document everything • Considered legally admissible evidence • Anything said is hearsay • Have a witness even throughout transport
- 31. 31 Protection Involves • Involve other medical responders who can testify on your behalf • Use responders of the same gender • Involve third-party witness • Carefully documenting your physical assessment • Have witness sign a written report of incident
- 32. 32 • Stupor -Stupor is defined as a state of diminished consciousness in which the patient remains mute but still the eyes remain open. • Catatonia - Catatonia is manifested through negativism, catalepsy, mutism, stereotypes, verbigeration, echolalia and echopraxia, excitement and impulsiveness.
- 33. 33 Management -Stuporous patient • Maintain hydration • Check vital signs • Keep airway patent • Give ventillatory support if needed • Care of skin, nutrition, elimination and personal hygiene • Identify specific cause and treat
- 34. 34 Management -catatonia • Remove restraints • Talk in a soft firm voice • Sedate with Inj.Lorazepam 4mgs and Inj.Haloperidol 10 mgs IV • Collect history to rule out organic pathology • Carryout complete physical examination • Treat dehydration