Behavioral Emergencies


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Behavioral Emergencies

  1. 1. Chapter Behavioral Emergencies Nineteen
  2. 2. Chapter <ul><li>Assessment of psychiatric presentation </li></ul><ul><li>Differentiation between altered mental status caused by psychiatric condition and altered mental status from medical or traumatic conditions </li></ul><ul><li>Care for psychiatric patients </li></ul><ul><li>Safe and effective use of restraints </li></ul>Nineteen CORE CONCEPTS
  3. 3. Behavioral Emergency A situation in which the patient exhibits behavior that is unacceptable or intolerable to the patient, family, or community Behavior The manner in which a person acts K EY TERMS
  4. 4. <ul><li>Low blood sugar </li></ul><ul><li>Lack of oxygen </li></ul><ul><li>Inadequate blood flow to brain </li></ul><ul><li>Head trauma </li></ul><ul><li>Mind-altering substances </li></ul><ul><li>Excessive cold </li></ul><ul><li>Excessive heat </li></ul><ul><li>Psychological crises </li></ul>Causes of Behavioral Change
  5. 5. <ul><li>Panic </li></ul><ul><li>Agitation </li></ul><ul><li>Bizarre thinking and behavior </li></ul><ul><li>Danger to self </li></ul><ul><li>Danger to others </li></ul>Psychological Crises
  6. 6. <ul><li>Identify yourself and your role. </li></ul><ul><li>Inform patient what you are doing. </li></ul><ul><li>Ask questions in a calm, reassuring voice. </li></ul>Actions to Take (Continued) Behavioral Emergencies
  7. 7. <ul><li>Do not be judgmental. </li></ul><ul><li>Acknowledge patient’s feelings. </li></ul><ul><li>Show you are listening by rephrasing what is said. </li></ul><ul><li>Treat patient with respect. </li></ul>Actions to Take Behavioral Emergencies
  8. 8. Patient ASSESSMENT Behavioral Emergencies Signs and Symptoms <ul><li>Assess the patient ’s mental status: </li></ul><ul><li>Appearance </li></ul><ul><li>Activity </li></ul><ul><li>Speech </li></ul><ul><li>Orientation </li></ul>(Continued)
  9. 9. Patient ASSESSMENT Behavioral Emergencies Signs and Symptoms <ul><li>Assess for potential violence: </li></ul><ul><li>History of violent behavior </li></ul><ul><li>Posturing </li></ul><ul><li>Vocal activity </li></ul><ul><li>Physical activity </li></ul>
  10. 10. Patient CARE Behavioral Emergencies Emergency Care Steps <ul><li>Maintain a comfortable distance. </li></ul><ul><li>Encourage patient to talk. </li></ul><ul><li>Do not make quick moves. </li></ul><ul><li>Respond honestly to questions. </li></ul>(Continued)
  11. 11. Patient CARE Behavioral Emergencies Emergency Care Steps <ul><li>Do not threaten, challenge, or argue. </li></ul><ul><li>Do not play along with visual or auditory disturbances. </li></ul><ul><li>Involve trusted family or friends. </li></ul>(Continued)
  12. 12. Patient CARE Behavioral Emergencies Emergency Care Steps <ul><li>Be prepared to spend time with patient. </li></ul><ul><li>Avoid unnecessary physical contact. </li></ul><ul><li>Use positive eye contact. </li></ul><ul><li>Restrain if necessary. </li></ul>
  13. 13. Use of Restraints <ul><li>Emotionally disturbed patients may refuse care. </li></ul><ul><li>For care to be provided against patient’s wishes, patient must be harmful to self/others. </li></ul>Medical-Legal Implications (Continued)
  14. 14. <ul><li>If patient is a threat to self or others, you may transport without consent. </li></ul>Medical-Legal Implications <ul><li>May require medical direction. </li></ul><ul><li>Usually requires law enforcement. </li></ul>(Continued) Use of Restraints
  15. 15. <ul><li>Have adequate help. </li></ul><ul><li>Plan. </li></ul><ul><li>Stay clear of patient until prepared. </li></ul>(Continued) Use of Restraints
  16. 16. <ul><li>Once decision is made — act quickly. </li></ul><ul><li>Have one EMT-B talk patient through process. </li></ul><ul><li>Secure patient with approved position/materials. </li></ul>(Continued) Use of Restraints
  17. 17. <ul><li>Use reasonable force to prevent patient from injuring self, others. </li></ul><ul><li>Avoid force that may injure </li></ul>patient. (Continued) Use of Restraints
  18. 18. <ul><li>Reasonable force determined by: </li></ul><ul><li>Patient’s size and strength </li></ul><ul><li>Type of abnormal behavior </li></ul><ul><li>Sex of patient </li></ul><ul><li>Mental state of patient </li></ul><ul><li>Method of restraint </li></ul>Use of Restraints
  19. 19. Death of a restrained patient — possibly due to respiratory problems caused by restraint Positional Asphyxia K EY TERM
  20. 20. <ul><li>Preventing Positional Asphyxia </li></ul><ul><li>Do not use hog-tie as a hobble restraint. </li></ul><ul><li>Position patient face up when possible. </li></ul><ul><li>Monitor patient carefully while restrained. </li></ul>
  21. 21. <ul><li>Reassess patient frequently. </li></ul><ul><li>Document incident thoroughly: </li></ul><ul><li>Indications </li></ul><ul><li>Methods </li></ul><ul><li>Witnesses </li></ul>Use of Restraints
  22. 22. <ul><li>Over 40 years old; single, widowed, or divorced; alcoholic; depressed </li></ul><ul><li>Lethal plan of action </li></ul><ul><li>Possession of articles capable of </li></ul>causing death (gun, pills) (Continued) Suicide Risk Factors
  23. 23. <ul><li>Previous history of self- destructive behavior </li></ul><ul><li>Recent diagnosis of serious illness </li></ul><ul><li>Recent loss of loved one </li></ul><ul><li>Arrest, imprisonment, loss of job </li></ul>Suicide Risk Factors
  24. 24. Patient ASSESSMENT Suicidal Behavior Signs and Symptoms Size-up is important. Beware of dangers: <ul><li>Display of self-destructive behavior or thoughts </li></ul><ul><li>Illness or injury resulting from previous attempts </li></ul>
  25. 25. Patient ASSESSMENT Breathing Adequacy Signs and Symptoms <ul><li>How does patient feel? </li></ul><ul><li>Suicidal tendencies? </li></ul><ul><li>Is patient a threat to self/others? </li></ul><ul><li>Is there a medical problem? </li></ul>
  26. 26. Patient CARE Suicidal Behavior: Emergency Care Steps <ul><li>Size-up, personal safety concerns. </li></ul><ul><li>Perform patient assessment. </li></ul><ul><li>Calm the patient. </li></ul><ul><li>Do not leave patient alone. </li></ul><ul><li>Restrain, if necessary. </li></ul><ul><li>Consider need for law enforcement. </li></ul><ul><li>Transport. </li></ul>
  27. 27. 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.” P RECEPTOR P EARL
  28. 28. 1. List several causes for behavioral change. 2. Describe several verbal and physical methods for assessment of a behavioral emergency. 3. Explain how to safely apply a restraint. R EVIEW QUESTIONS