Transcript Behavioral Emergencies

Drill of the Month
Developed by Gloria Bizjak
Behavioral Emergencies
Drill of the Month
Behavioral Emergencies
Student
Performance Objective:
Given
information, resources, and opportunity for
discussion, EMTs will be able to:
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Define behavioral emergencies
List causes of behavioral emergencies
List signs and symptoms
State actions and precautions for safety
Describe assessment and care steps
EMTs
will follow acceptable Maryland medical practice
and Maryland Medical Protocols for Emergency Medical
Providers.
Drill of the Month
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Altered Mental Status: Assessing
and Managing Seizure Patients
Overview
 Behavioral Emergencies: Definition
 Causes of Behavioral Emergencies
 Signs and Symptoms
 Actions and Precautions
 Assessment and Care Steps
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Behavioral Emergencies: Definition
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Abnormal or atypical behavior that is
unacceptable in a given situation with the
potential that serious harm is imminent
Unusual and seriously alarming behavior
– Threats to harm self, particularly suicide
– Threats to harm others
– Threats to cause serious property damage
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Behavioral Emergencies: Definition
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Any medical/trauma situation that alters
normal behavior and physical functioning
NOTE:
Consider all behavioral emergencies as
incidents of altered mental status
Do not overlook medical conditions
– abnormal blood sugar level, hypoxia, stroke,
tumor, drug or alcohol intoxication, pain,
medications, severe infections
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Causes of Behavioral Emergencies
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Trauma
– Head injury—recent or past
 Periodic irritability
 Irrational behavior
 Confusion and frustration
 Amnesia
 Delusions
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Causes of Behavioral Emergencies
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Amputation
– Medical—losing a body part can be
– mentally traumatic
– Traumatic—losing a body part in a crash or
other trauma incident can be
– mentally traumatic
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Causes of Behavioral Emergencies
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Medical
– Metabolic disorders
 Hypoglycemia
 Hyperglycemia
 Endocrine, or hormonal disorders
– Stroke
– Epilepsy
– History of or admission of depression
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Causes of Behavioral Emergencies
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Medical
– Hypoxia
– Mind-altering substance use
– Alcohol or drug abuse
– Poison exposure or ingestion
– Environmental
 Hypothermia
 Hyperthermia
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Causes of Behavioral Emergencies
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Neurological
– Organic brain disorder
– Other medical conditions with organic causes
 Lesions
 Tumors
 Degenerative diseases
 (Alzheimer’s, Parkinson’s, dementia)
 Infections
 Toxins
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Causes of Behavioral Emergencies
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Stress response or any situation that causes
prolonged, extreme stress or sever anger,
fear, or grief
– Loss of a loved one
– Work/job problems or loss
– Home/family problems
– Money problems
– Health problems
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Causes of Behavioral Emergencies
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Psychiatric disorders
– History of mental illness, behavioral problems
– Overdose of/forgetting to take psychiatric meds
– Thought processes not logical to, or consistent
with, situation
– Unaware of surroundings or situation
– Delusions or hallucinations
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Signs and Symptoms
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Observable signs
– Body language: Expressions or actions
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Agitation—anxious, restless, panicky, nervous,
rapid speech and movement
Anger, aggressively hostile
Defiance
Violence: Threatening self, others
Suicidal gestures or talk
Shouting, crying out, crying
Isolates self, refuses to talk
Obsessive-compulsive actions
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Signs and Symptoms
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Observable signs
– Personal appearance: Poor hygiene,
grooming, dress
– History of alcohol or drug abuse
– Delusions or visions: Hears voices, may
want to follow “orders” of voices; talks to
unseen persons
– Persecution: Believes others are plotting
against him, no one understands him,
blames others for problems
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Signs and Symptoms
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Observable signs
– Speech or language
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Cannot talk or does not appear to understand
what you are saying (aphasia)
Result of brain injury (head trauma, stroke, brain
tumor, neurological disease, epilepsy, migraine)
to specific brain areas—NOT a cognitive disorder
– Broca’s area—controls language/speech
– Wernicke’s area—control language interpretation
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Talks, but word choice is unusual
– Quality, pace, articulation
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Signs and Symptoms
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Observable signs
– Age (with any of the above signs)
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15-25 years of age
Over 40 years of age
The elderly
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Signs and Symptoms
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Symptoms
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Possible rapid pulse rate
Possible rapid breathing rate
Trouble breathing
Complains of headache or other pains
Depression or suddenly coming out of a
depression and feeling better
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Actions and Precautions
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General
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Assess the scene for dangers or safety problems
Protect yourself and others
Watch for changes in behavior from calm to violent
Be alert for weapons or items that can be used as
weapons
Have family members, friends, others leave room or
area if patient is agitated by their presence
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Alternately, have someone stay if that person helps calm
patient or patient responds positively to that person
Take safety actions with threat of danger
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Retreat, call law enforcement
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Actions and Precautions
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Specific
– The suicidal patient
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Take suicidal threats seriously
Get eye-level with patient; sit next to patient;
maintain eye contact
Talk to patient about thoughts and feelings; listen
Talk to patient about previous attempts or plans
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Actions and Precautions
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Specific
– The aggressive or hostile patient
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Ensure safety: Watch for sudden changes in
behavior, movements, actions
Be alert for weapons
Call for assistance from law enforcement
Call for medical direction if necessary
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Actions and Precautions
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Specific
– The psychiatric patient
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Ensure safety: Watch for sudden changes in
behavior, movements, actions
Care for medical/trauma problems first, if possible
Talk with the patient in a calm, reassuring voice
Encourage conversation about problems; listen
Use positive body language: Smile, position self at
eye level, have hands relaxed at sides or in lap
Do not play along with hallucinations
Do not lie or make promises you cannot fulfill
Involve family members if it is safe or helpful
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Actions and Precautions
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Specific
– The patient reacting to stress
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Act calmly and take control of the situation
Let the patient know you are there to help
Treat the patient as an individual who has
feelings and merit
Do not rush the assessment or interview
Give the patient time to interact with you
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Assessment and Care Steps
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Assessment: Perform General Patient Care
(Refer to Maryland Protocols pp 25 pp 31 pp 34 (K) pp
37 – 38 – 38-1 pp 42-43
– Gather information on approach
– Size up the scene
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Ensure scene safety
Limit the number of people around the patient
Avoid overwhelming the patient with too many
people, too many people talking, too many sounds
Respect the patient’s personal space
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Assessment and Care Steps
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Assessment: Perform General Patient Care
(Refer to Maryland Protocols pp 25 pp 31 pp 34 (K) pp
37 – 38 – 38-1 pp 42-43 )
– Perform initial assessment to extent possible
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Mental status
– Assess memory, concentration, judgment, orientation
– Assess mood: facial expressions, body language, response
to questions
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Airway, breathing, circulation
Provide oxygen if possible
Disability: pulse/motor/sensory
Expose to assess injuries
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Assessment and Care Steps
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Assessment: Perform General Patient Care
(Refer to Maryland Protocols pp 25 pp 31 pp 34 (K) pp
37 – 38 – 38-1 pp 42-43 )
– Perform focused history and physical exam—
expect distorted information
 History to the extent possible: SAMPLE
– Patient may be uncooperative
– Patient may provide unreliable history
– Family or caretakers may be unavailable or not
know full history
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Assessment and Care Steps
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Assessment: Perform General Patient Care
(Refer to Maryland Protocols pp 25 pp 31 pp 34 (K) pp
37 – 38 – 38-1 pp 42-43 )
– Perform focused history and physical exam—
expect distorted information
 Physical assessment to the extent possible:
– DCAP-BTLS
– AEIOU-TIPS
• Alcohol or acidosis
•Epilepsy (seizures
• Infection (sepsis)
• Overdose
• Uremia
• Uremia
• Trauma or tumor
• Insulin (hyperglycemia or hypoglycemia
• Poisonings or psychosis
• Stroke
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Assessment and Care Steps
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Assessment: Perform General Patient Care
(Refer to Maryland Protocols pp 25 pp 31 pp 34 (K) pp 37 – 38 –
38-1 pp 42-43 )
– Mental assessment: AABCST
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Appearance: patient’s age, sex, hygiene, posture,
dress (appropriate for season, situation/event,
e.g., dressed for bed at a birthday party)
Affect: what feelings the patient is demonstrating
Behavior: what patient is doing
Cognition: patient’s consciousness level, memory,
mood
Speech: patient’s word choice, tone, clarity,
content, pace
Thought processes: whether patient shows
reasonable judgment for the situation
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Assessment and Care Steps
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Assessment: Perform General Patient Care
(Refer to Maryland Protocols pp 25 pp 31 pp 34 (K) pp
37 – 38 – 38-1 pp 42-43 )
– Follow treatment protocols
– Communicate with hospital or other response
personnel
– Determine priority and mode of transport and
where
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Assessment and Care Steps
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Emergency Care
(Refer to Maryland Protocols p. 42)
– Use restraints as necessary
– Law enforcement Must be considered
 Transporting from medical facility: obtain
physician order
 Transporting from field/home: call law
enforcement to apply and accompany
patient in unit
 SAFER model (Maryland Protocol p. 42)
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Assessment and Care Steps
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Emergency Care
(Refer to Maryland Protocols p. 42)
– Use restraints as necessary
 Always use soft, humane restraints
 Have enough personnel to perform the
restraint
– One person for each extremity; one person for
the head; one person to apply restraints
– Coordinate actions
– Be cautions of kicking, scratching, biting
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Assessment and Care Steps
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Emergency Care (Maryland Protocols p. 42)
– Use restraints as necessary
 Restrain in a supine position, never prone
 Continuously monitor the restrained patient
– Check breathing and pulse
– Be alert for the struggling or agitated patient
who suddenly becomes calm and quiet
 Check responsiveness, breathing, pulse
 Be aware of faking, attempts to attack or
injure you
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Assessment and Care Steps
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Emergency Care (Maryland Protocols p. 42)
– Implement SAFER model
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Stabilize situation: stop influence of sensations
Assess and acknowledge crisis
Facilitate/help patient understand situation; access
resources
Encourage use of resources and coping
Recovery or Referral: responsible person or
professional or transport
– Transport/transfer/transition patient and
information
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Behavioral Emergencies
Student
Performance Objective:
Given
information, resources, and opportunity for
discussion, EMTs will be able to:
Define behavioral emergencies
• List causes of behavioral emergencies
• List signs and symptoms
• State actions and precautions for safety
• Describe assessment and care steps
•
EMTs
will follow acceptable Maryland medical practice
and Maryland Medical Protocols for Emergency Medical
Providers.
Drill of the Month
33
Behavioral Emergencies
Review
 Behavioral Emergencies: Definition
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– Provide at lease one definition or description of a
behavioral emergency
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Causes: Name at lease one behavioral emergency
indication for each of the following
 Trauma
 Medical
 Neurological
 Stress
 Psychiatric
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Behavioral Emergencies
Review
 Signs and symptoms
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– Name at least 5 observable signs of a
behavioral emergency
– What are some general symptoms of a
behavioral emergency?
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Behavioral Emergencies
Review
 Actions and Precautions
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– What are general actions and precautions to
take for the behavioral emergency patient?
– What are specific actions and precautions to
take for each of the following situations?
 Suicidal patient
 Aggressive or hostile patient
 Psychiatric patient
 Patient reacting to stress
Drill of the Month
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Behavioral Emergencies
Review
 Assessment and Care Steps
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– List assessment steps for the behavioral
emergency patient
– List the care steps for the behavioral
emergency patient
 What are the protocols for using restraints?
 What are the steps of the SAFER model?
Drill of the Month
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