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behavioral emergencies - I.ppt
- 2. 2 Behavioral Emergencies ⢠Person exhibits âabnormalâ behavior ⢠Threat to self, family, or community ⢠Patient may display â Panic â Agitation â 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 â Dizziness â Tingling around mouth and fingers â Carpal-pedal spasms â Tremors â Irregular heartbeat â Palpitations â Diarrhea â Sob, choking, smothering â 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 ⢠Factor in approximately 50% of suicides ⢠Crying spells, listless or apathetic behavior ⢠Feel helpless, hopeless, withdrawn, pessimistic ⢠Suffer appetite loss, sleeplessness, fatigue, despondence, and severe restlessness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 ⢠âSomeone is out to get themâ ⢠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 âjust trying to get attentionâ ⢠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 âget betterâ ⢠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 patientâs cooperation ⢠Maintain good eye contact ⢠Do not make any quick movements ⢠Respond honestly to questions, donât foster unrealistic expectations ⢠Never threaten, challenge, belittle, or argue with patient
- 20. 20 Techniques for Treatment Cont.. ⢠Always tell the truth ⢠Donât 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 â Suicide pacts
- 24. 24 Suicidal Patient Assessment ⢠Related injuries or medical conditions primary concern ⢠Listen carefully ⢠Accept all patientâs complaints and feelings ⢠Do not trust ârapid recoveriesâ ⢠Be specific in your actions ⢠Never show disgust or horror, Watch your body language ⢠Donât deny that suicide attempt occurred ⢠Never try to shock the patient out of suicide attempt
- 25. 25 Violent Patient Assessment ⢠Take history ⢠Observe patientâs posture ⢠Listen to patient ⢠Monitor the patientâs 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 patientâs 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 â Soft restraints are reasonable â 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