behavioral emergencies
TRANSCRIPT
ChapterChapter
BehavioralBehavioral
EmergenciesEmergencies
NineteenNineteen
ChapterChapter
Assessment of psychiatric presentation
Differentiation between altered mental status caused by psychiatric condition and altered mental status from medical or traumatic conditions Care for psychiatric patients Safe and effective use of restraints
NineteenNineteenCORE CONCEPTSCORE CONCEPTS
Behavioral EmergencyBehavioral Emergency
A situation in which the patient exhibits A situation in which the patient exhibits behavior that is unacceptable or intolerable behavior that is unacceptable or intolerable to the patient, family, or communityto the patient, family, or community
BehaviorBehavior
The manner in which a person actsThe manner in which a person acts
KKEY TERMSEY TERMS
Low blood sugarLow blood sugar Lack of oxygenLack of oxygen Inadequate blood flow to brainInadequate blood flow to brain Head traumaHead trauma Mind-altering substancesMind-altering substances Excessive coldExcessive cold Excessive heatExcessive heat Psychological crisesPsychological crises
Causes of Behavioral ChangeCauses of Behavioral Change
PanicPanic AgitationAgitation Bizarre thinking and behaviorBizarre thinking and behavior Danger to selfDanger to self Danger to othersDanger to others
Psychological CrisesPsychological Crises
Identify yourself and your role.
Inform patient what you are doing.
Ask questions in a calm, reassuring voice.
ActionsActionsto Taketo Take
(Continued)(Continued)
Behavioral EmergenciesBehavioral Emergencies
Do not be judgmental. Acknowledge patient’s feelings. Show you are listening by rephrasing what is said. Treat patient with respect.
ActionsActions
to Taketo Take
Behavioral EmergenciesBehavioral Emergencies
Patient Patient ASSESSMENTASSESSMENT
Behavioral EmergenciesBehavioral Emergencies
Signs and SymptomsSigns and Symptoms
Assess the patientAssess the patient ’s mental status:’s mental status:• AppearanceAppearance• ActivityActivity• SpeechSpeech• OrientationOrientation
(Continued)(Continued)
Patient Patient ASSESSMENTASSESSMENT
Behavioral EmergenciesBehavioral Emergencies
Signs and SymptomsSigns and Symptoms
Assess for potential violence:Assess for potential violence:• History of violent behaviorHistory of violent behavior• PosturingPosturing• Vocal activityVocal activity• Physical activityPhysical activity
Patient Patient CARECARE
Behavioral EmergenciesBehavioral Emergencies
Emergency Care StepsEmergency Care Steps
Maintain a comfortable distance.Maintain a comfortable distance. Encourage patient to talk.Encourage patient to talk. Do not make quick moves.Do not make quick moves. Respond honestly to questions.Respond honestly to questions.
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Patient Patient CARECARE
Behavioral EmergenciesBehavioral Emergencies
Emergency Care StepsEmergency Care Steps
Do not threaten, challenge, or argue.Do not threaten, challenge, or argue. Do not play along with visual orDo not play along with visual or auditory disturbances. auditory disturbances. Involve trusted family or friends.Involve trusted family or friends.
(Continued)(Continued)
Patient Patient CARECARE
Behavioral EmergenciesBehavioral Emergencies
Emergency Care StepsEmergency Care Steps
Be prepared to spend time withBe prepared to spend time with patient. patient. Avoid unnecessary physical contact.Avoid unnecessary physical contact. Use positive eye contact.Use positive eye contact. Restrain if necessary.Restrain if necessary.
Use of RestraintsUse of Restraints
Emotionally disturbed patientsEmotionally disturbed patients may refuse care. may refuse care.
For care to be provided against For care to be provided against
patient’s wishes, patient must be patient’s wishes, patient must be
harmful to self/others. harmful to self/others.
Medical-Legal Implications
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If patient is a threat to self or others,If patient is a threat to self or others, you may transport without consent. you may transport without consent.
Medical-Legal Implications
May require medical direction.May require medical direction.
Usually requires law enforcement.Usually requires law enforcement.
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Use of RestraintsUse of Restraints
Have adequate help.Have adequate help. Plan.Plan. Stay clear of patient until prepared.Stay clear of patient until prepared.
(Continued)(Continued)
Use of RestraintsUse of Restraints
Once decision is made — act quickly. Once decision is made — act quickly. Have one EMT-B talk patient through process.
Secure patient with approved position/materials.
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Use of RestraintsUse of Restraints
Use reasonable force to preventUse reasonable force to prevent patient from injuring self, others. patient from injuring self, others.
Avoid force that may injure Avoid force that may injure patient.patient.
(Continued)(Continued)
Use of RestraintsUse of Restraints
Reasonable force determined by: Reasonable force determined by:
Patient’s size and strength Type of abnormal behavior Sex of patient Mental state of patient Method of restraint
Use of RestraintsUse of Restraints
Positional AsphyxiaPositional Asphyxia
Death of a restrained patient — possibly Death of a restrained patient — possibly due to respiratory problems caused due to respiratory problems caused by restraintby restraint
KKEY TERMEY TERM
Preventing Positional Preventing Positional AsphyxiaAsphyxia• Do not use hog-tie as a hobble Do not use hog-tie as a hobble
restraint.restraint.
• Position patient face up when possible.Position patient face up when possible.
• Monitor patient carefully while Monitor patient carefully while restrained.restrained.
Reassess patient frequently.Reassess patient frequently. Document incident thoroughly:Document incident thoroughly:
• IndicationsIndications• MethodsMethods• WitnessesWitnesses
Use of RestraintsUse of Restraints
Over 40 years old; single,Over 40 years old; single, widowed, or divorced; widowed, or divorced; alcoholic; depressed alcoholic; depressed
Lethal plan of actionLethal plan of action
Possession of articles capable ofPossession of articles capable ofcausing death (gun, pills)causing death (gun, pills)
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Suicide Risk FactorsSuicide Risk Factors
Previous history of self-Previous history of self- destructive behavior destructive behavior
Recent diagnosis of serious illnessRecent diagnosis of serious illness
Recent loss of loved oneRecent loss of loved one
Arrest, imprisonment, loss of jobArrest, imprisonment, loss of job
Suicide Risk FactorsSuicide Risk Factors
Patient Patient ASSESSMENTASSESSMENT
Suicidal BehaviorSuicidal Behavior
Signs and SymptomsSigns and Symptoms
Size-up is important. Beware of dangers:Size-up is important. Beware of dangers:
Display of self-destructive behaviorDisplay of self-destructive behavior or thoughts or thoughts Illness or injury resulting fromIllness or injury resulting from previous attempts previous attempts
Patient Patient ASSESSMENTASSESSMENT
Breathing AdequacyBreathing Adequacy
Signs and SymptomsSigns and Symptoms
How does patient feel?How does patient feel? Suicidal tendencies?Suicidal tendencies? Is patient a threat to self/others?Is patient a threat to self/others? Is there a medical problem?Is there a medical problem?
Patient Patient CARECARE
Suicidal Behavior: Emergency Care StepsSuicidal Behavior: Emergency Care Steps
Size-up, personal safety concerns.Size-up, personal safety concerns. Perform patient assessment.Perform patient assessment. Calm the patient.Calm the patient. Do not leave patient alone.Do not leave patient alone. Restrain, if necessary.Restrain, if necessary. Consider need for law enforcement.Consider need for law enforcement. Transport.Transport.
Assessment and care of the behavioral emergency patient require a high level of caution. Experienced EMT-Bs know that anything can happen at any time. Newly certified EMT-Bs should be reminded to maintain a safe distance when managing all behavioral emergency patients. Tell them that management of the behavioral emergency takes a while, and as an EMT-B, they must be prepared to spend time with the patient. Encourage them to remember that these types of calls require that they become “patient with the patient.”
PPRECEPTOR RECEPTOR PPEARLEARL
1. List several causes for behavioral1. List several causes for behavioral change. change.2. Describe several verbal and physical2. Describe several verbal and physical methods for assessment of a methods for assessment of a behavioral emergency. behavioral emergency.3. Explain how to safely apply a restraint.3. Explain how to safely apply a restraint.
RREVIEW QUESTIONSEVIEW QUESTIONS