behavioral emergencies - shenandoah county · 2011-10-13 · chapter 23 behavioral emergencies...
TRANSCRIPT
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CHAPTER 23
Behavioral Emergencies
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Emergencies
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Causes of Causes of BehavioralBehavioral
ChangeChange
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
ChangeChange
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Behavior
Key Term
The manner in which a person acts
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
The manner in which a person acts
or performs
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Behavioral Emergency
A situation in which the patient
exhibits abnormal behavior within a
Key Term
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
exhibits abnormal behavior within a
given situation that is unacceptable
or intolerable to the patient, family, or
community
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Causes of Behavioral Change
Low blood sugar
Lack of oxygen
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Inadequate blood flow to brain or
stroke
Head trauma
Continued…
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Causes of Behavioral Change
Mind-altering substances
Excessive heat or cold
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Psychological crises
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Psychological Crises
Panic
Agitation
Bizarre thinking and
behavior
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
behavior
Danger to self
Danger to others
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BehavioralBehavioralEmergenciesEmergencies
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
EmergenciesEmergencies
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Behavioral Emergencies
Size up scene carefully.
Identify yourself, your
role.
Inform patient what you
Actionsto Take
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Inform patient what you
are doing.
Ask questions in a calm,
reassuring voice.
Do not rush.
Continued…
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Do not be judgmental.
Acknowledge patient’s
feelings.
Show you are listening by
Behavioral Emergencies
Actionsto Take
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Show you are listening by
rephrasing what is said.
Treat patient with respect.
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Assessing BehavioralEmergencies
What is the patient’s mental status?
Appearance (clothing, hygiene)
Activity
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Activity
Speech
Orientation
Continued…
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Any potential violence?
History of violent behavior
Posturing
Assessing BehavioralEmergencies
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Posturing
Voice level/tone
Physical activity
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Emergency Care forBehavioral Emergencies
Maintain a comfortable distance.
Encourage patient to talk.
Do not make quick moves.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Do not make quick moves.
Respond honestly to questions.
Continued…
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Emergency Care forBehavioral Emergencies
Do not threaten, challenge, or
argue.
Do not play along with visual or
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Do not play along with visual or
auditory disturbances.
Involve trusted family or friends.
Continued…
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Be prepared to spend time with
patient.
Avoid unnecessary physical
Emergency Care forBehavioral Emergencies
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Avoid unnecessary physical
contact.
Use positive eye contact.
Restrain if necessary.
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SuicidalSuicidalBehaviorBehavior
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
BehaviorBehavior
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Suicide Risk Factors
15-25 years old, or over 40 years old,
are high risk, but any age is possible
Alcohol or drug abuse
Lethal plan of action
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Lethal plan of action
Gathering articles capable of
causing death (gun, pills, etc.)
Continued…
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Depression or high stress levels
Previous history of self-destructive
behavior
Recent diagnosis of serious illness
Suicide Risk Factors
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Recent diagnosis of serious illness
Recent loss of loved one
Continued…
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Arrest, imprisonment, loss of job
Sudden improvement from
Suicide Risk Factors
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Sudden improvement from depression
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Size-Up During SuicidalBehavior
Any display of self-destructive
behavior or thoughts?
Illness or injury from previous
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Illness or injury from previous
attempts?
Continued…
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Size-Up During SuicidalBehavior
How does patient feel?
Is patient a threat to self/others?
Is there a medical problem?
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Is there a medical problem?
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Safety Considerations
Have an escape route.
Never enter a scene alone.
Be alert for weapons or potential
weapons.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
weapons.
Watch for sudden changes of
behavior.
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Emergency Care forSuicidal Behavior
Size up scene and your safety
concerns.
Utilize police department as
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Utilize police department as
needed.
Perform patient assessment.
Continued…
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Emergency Care forSuicidal Behavior
Calm the patient.
Do not leave patient alone.
Restrain, if necessary.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Restrain, if necessary.
Transport.
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Use ofUse ofRestraintsRestraints
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
RestraintsRestraints
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Use of Restraints:Medical-Legal Implications
Emotionally disturbed patients may
refuse care.
To provide care against patient’s
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
To provide care against patient’s
wishes, patient must be harmful to
self/others.
Continued…
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If patient is a threat to self or
others, may transport without
consent
Use of Restraints:Medical-Legal Implications
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
consent
May require medical direction
Usually requires law enforcement
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Have adequate help.
Plan ahead.
Stay clear of patient until prepared.
Use of Restraints
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Stay clear of patient until prepared.
Continued…
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Use of Restraints
Once a
decision is
made, act
quickly.
Have one EMT–B talk
patient through
process.
Secure patient with
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
quickly. Secure patient with
approved position/
materials.
Secure all 4 limbs.
Continued…
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Use reasonable force to prevent patient from injuring self and others.
Avoid force that may injure
Use of Restraints
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Avoid force that may injure patient.
Continued…
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Use of Restraints
Patient’s size and strength
Type of abnormal behavior
Reasonable force determined by:
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Type of abnormal behavior
Sex of patient
Mental state of patient
Method of restraint
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Positional Asphyxia
Key Term
Death of a restrained patient —
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Death of a restrained patient —possibly due to respiratory problems caused by restraint
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Do not use hog-tie as a hobble
restrain.
Position patient face-up when
Preventing PositionalAsphyxia
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Position patient face-up when
possible.
Monitor patient carefully while
restrained.
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Reassess patient frequently.
Document incident thoroughly.
Indications
Methods
Use of Restraints
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Methods
Witnesses
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1. List several causes for behavioral
change.
2. Describe several verbal and
Review Questions
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
2. Describe several verbal and
physical methods for assessment
of a behavioral emergency.
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3. Describe the patient care for
behavioral emergencies.
4. List several risk factors for suicide.
Review Questions
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
4. List several risk factors for suicide.
5. Describe medical-legal implications
for use of restraints.
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What is your first and most
important concern?
STREET SCENESSTREET SCENES
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
important concern?
How should you handle the matter
of scene safety?
When should you approach the
patient?
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How should the patient be
approached?
STREET SCENESSTREET SCENES
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
approached?
What are the safety concerns when
working with an agitated patient?
Does this patient need a medical
assessment?
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Sample Documentation
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ