Chapter 26. Objectives. Objectives 01/09/2013. Behavioral Emergencies

Transcription

1 Chapter 26 Behavioral Emergencies Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Copyright 2010 by Pearson Education, Inc. All rights reserved. Objectives 1. Define key terms introduced in this chapter (slide 13). 2. Explain the importance of recognizing and responding to patients suffering from behavioral emergencies. 3. Describe indications of danger associated with response to behavioral emergencies (slide 34-35). 4. Discuss the underlying physical and psychological causes of behavioral emergencies (slides 14-15). 5. Describe the focus of assessment and history taking for patients who have behavioral emergencies (slides 14-15). Objectives 6. Recognize behavioral characteristics of the following conditions (slides 16-33): a. Anxiety b. Phobias c. Depression d. Bipolar disorder e. Paranoia f. Psychosis g. Schizophrenia h. Agitated delirium 7. Describe risk factors associated with suicide and violence toward others (slides 34-35). 8. Discuss basic principles related to the assessment and management of patients with behavioral emergencies (slides 39-40). 1

2 Objectives 9. Recognize indications of attempted suicide during scene size-up and patient assessment (slides 30-31) 10. Prioritize patient care needs in terms of managing physical and behavioral problems (slides 41-53). 11. Recognize indications for physical restraint of a patient and follow principles of safe physical restraint of patients (slides 54-56). 12. Evaluate the need for law enforcement and medical direction involvement in a behavioral emergency situation (slides 55-61, 64-65). 13. Document all information pertinent to calls involving behavioral emergencies and patient restraint (slide 67). Multimedia Directory Slide 36 Slide 37 Slide 56 Personal Account of Battle with Anorexia Video Personal Account of Battle with Bulimia Video Soft Restraints Video Topics Behavioral Problems Dealing with Behavioral Emergencies Legal Considerations 2

3 CASE STUDY Dispatch EMS Unit 204 Respond to 3486 East Market Street, King s Motel, Room 22 for a woman who is cut and bleeding. Time out 2235 Upon Arrival Motel manager unaware of troubles; leads you to Room 22 You knock and hear a woman answer; she denies anyone else is present and states, No, there s no one here. There s never anyone here. Never. No one cares. No, there s no one. 3

4 Upon Arrival Find patient in the middle of the bathroom Cut on the left wrist and a large hunting knife in her right hand How would you proceed to assess and care for this patient? Behavioral Problems Back to Topics 4

5 Behavior Behavioral emergencies Back to Objectives Behavioral Change Back to Objectives Common reasons for behavioral changes Assessment findings 5

6 Psychiatric Problems Anxiety Back to Objectives Anxiety Characteristics Panic attack Signs and symptoms Psychiatric Problems Phobias 6

7 Phobias Related to anxiety Signs of phobias Psychiatric Problems Depression Depression Characteristics Suicide Signs and symptoms 7

8 Psychiatric Problems Bipolar Disorder Bipolar Disorder Phases Signs and symptoms Duration Psychiatric Problems Paranoia 8

9 Paranoia Characteristics Signs and symptoms Psychiatric Problems Psychosis Psychosis Characteristics Signs and symptoms 9

10 Psychiatric Problems Schizophrenia Schizophrenia Group of mental disorders Signs and symptoms Violence Suicide Back to Objectives 10

11 Suicide Definition Statistics Common methods High risk factors Craig Jackson/In the Dark Photography Violence Agitated Delirium Agitated Delirium Characteristics Hazards Complications 11

12 Violence Violence to Others Back to Objectives Violence to Others Causes Early signs Personal Account of Battle with Anorexia Click here to view a video of a personal account of a battle with anorexia. Return to Directory 12

13 Personal Account of Battle with Bulimia Click here to view a video of a personal account of a battle with bulimia. Return to Directory Dealing with Behavioral Emergencies Back to Topics Basic Principles Back to Objectives 13

14 Limitations Feelings Coping Emotional injury is real They do not just get better Cultural differences Techniques for Treating Behavioral Emergency Patients Back to Objectives Therapeutic techniques Assessment tips 14

15 Assessment-Based Approach: Behavioral Emergencies Scene Size-Up Scene Size-Up Pay attention to dispatch information Check scene safety Locate patient visually Never let guard down Rule out medical/trauma causes Assessment-Based Approach: Behavioral Emergencies Primary Assessment 15

16 Primary Assessment General impression Mental status LOC ABCs O 2 Assessment-Based Approach: Behavioral Emergencies Secondary Assessment Secondary Assessment History Chief complaint Physical exam Suicidal patients 16

17 Secondary Assessment Violent patients Signs and symptoms Assessment-Based Approach: Behavioral Emergencies Emergency Medical Care Emergency Medical Care Safety Assess for trauma or medical condition Calm patient Use restraints, if necessary Transport 17

18 Assessment-Based Approach: Behavioral Emergencies Reassessment Reassessment ABCs O 2 Mental status Vital signs Interventions Restraining a Patient Back to Objectives 18

19 Follow local protocols Do not restrain prone, hog tie, or hobble-restrain Use humane restraints Reassess frequently Back to Objectives How to Apply Soft Restraints Click here to view a video on the topic of how to apply soft restraints. Return to Directory Legal Considerations Back to Topics 19

20 Consent Consent Informed consent Implied consent Mentally competent Refusal of Care 20

21 Document all aspects of encounter Use refusal form Transport if patient threatens to hurt self or others Using Reasonable Force Reasonable force Size and strength Behavior Mental state Method of restraint 21

22 Police and Medical Direction Back to Objectives Seek medical direction prior to restraining a patient Involve law enforcement False Accusations 22

23 Document the encounter Have witnesses Use medical responder of the same gender as patient, if possible Back to Objectives CASE STUDY Follow-Up CASE STUDY Primary Assessment Patient puts the knife on the counter and moves away from it Patient s name is Maria Foster ; early 20s female Patient allows you to look at her wrist; the wound has stopped bleeding 23

24 CASE STUDY Primary Assessment Patient is alert/oriented; airway open; breathing adequate Patient consents to oxygen placement CASE STUDY Secondary Assessment Patient admits to trying to commit suicide but stopped after seeing blood NKA; NKM; no PMH; ate at 4:00 p.m. yesterday and drank two glasses of rum CASE STUDY Secondary Assessment BP: 148/84 mmhg; HR: 94; RR: 14 Consents to transport and wants her mother called Transport to hospital 24

25 CASE STUDY Treatment and Reassessment Still no bleeding present Vital signs stable Arrive at hospital; give report; transfer care Mother and patient thank you for your care Critical Thinking Scenario 26-year-old male with multiple self-inflicted stab wounds to his abdomen The patient refuses your care and will not let you come near him without becoming aggressive and violent He s alert and pacing while clutching his abdomen You re unable to conduct any type of assessment on the patient Critical Thinking Questions 1. What scene safety issues are involved? 2. How would you proceed in providing care for this patient? 3. What is your primary responsibility in managing the patient? 25

26 Critical Thinking Questions 4. Would you consider restraining this patient? 5. What criteria would you use to make the decision to restrain the patient? 6. How would you proceed in restraining the patient? Critical Thinking Questions 7. What are some hazards involving patient restraint? 8. What legal issues are of concern with this patient? Reinforce and Review Please visit and follow the mybradykit links to access content for the text. 26