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MANAGEMENT OF PSYCHIATRIC EMERGENCIES1BY:- FIROZ QURESHIDEPT. PSYCHIATRIC NURSING

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PSYCHIATRIC EMERGENCY:2A sudden onset of an unusual disorder, inappropriate behaviour caused by an emotional and physiological situation.Bimla Kapoor.

CHARACTERISTICS:3Stressors predispose the client and his family members to seek immediate intervention, as the feel more discomfort.Disharmony between client and his environment.Sudden, unexpected, disorganization in person. Unable to cope up with the stressful situation or failure in handling the stressor.

VIOLENT/AGGRESSIVE PATIENT4

Causes:5

Head injuryMetabolic disturbancesHyperthermia hypothermiaSubstance intoxication

Cont....6 ANY PSYCHIATRIC ILLNESSSEIZURESHYPOGYCEMIAHYPERTHERMIA , HYPOTHERMIA

RISK FACTORS:7Younger ageMale genderLower incomePast juvenile detentionHistory of physical abuse by parent or guardianSubstance dependence onlyUnemployed and looking for work in the past

ASSESSING THE VIOLENT / AGGRESSIVE PATIENT:8ASSESS BY ABC

9Question:- What should be the first action while patient hitting his head to the wall ?Answer:-?

Answer 10

MANAGEMENT OF THE VIOLENT/ AGGRESSIVE PATIENT:11

SUICIDAL THREAT: 12In psychiatry a suicidal attempt is considered to be one of the commonest emergencies. Suicide is a type of deliberate self-harm and is defined as an intentional human act of killing oneself.

1 in10 causes of death.In India- 10.8 per 1 lakhMale female ratio- 64:36Age group 15-29 years

ETIOLOGY:MAJOR DEPRESSIONSCHIZOPHRENIA13

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Substance abuse

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MANAGEMENT FOR SUICIDAL THREAT:16Be aware of the warning signs: 4S- Suicidal idea and behaviour. Severity of psychopathology. Stressor.Supporting system.

Cont....17

SEIZURES18

INTRODUCTION:19Seizure is a paroxysmal event due to abnormal neuronal activity in the brain.Seizures are episodes of abnormal motor , sensory, autonomic or psychic activity that results from sudden excessive discharge from cerebral neurons (Hickey, 2009)

CLASSIFICATION:20

RISK FACTORS:21

Head injury

CAUSES:

22Allergies High grade fever

Cont...

23Congenital abnormalities Alcohol withdrawal

CLINICAL MANIFESTATIONS DURING SIMPLE SEIZURES Loss of consciousnessonly a finger or hand may shake or mouth may jerk uncontrollably.Person may talk irrelevantlyDizziness Frothing from the mouth.

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ContPerson may experience unusual or unpleasant sight, sounds, odors or tastes with loss of consciousness.Intense rigidity of the entire body may occur.Tongue is often chewedIncontinent of urine or faeces

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In complete partial seizuresThe person either remains motionless, or moves automatically.He or she may experience fear, anger or irritability.DisorientedIncontinent of urine or fecesWhatever the manifestations , the person does not remember the episode when it is over.

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In generalised seizuresIntense rigidity of the entire body may occurTongue is often chewedAfter 1 or 2 min the convulsive movements begin to subside; the patient relaxes and lies in deep coma , breathing noisily.In this state the patient is often confused and hard to arouse and may sleep for hours.Many patients report headache, fatigue and depression.

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Management of seizures

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During seizuresProvide privacy and protect the patient from onlookers.Ease the patient to the floor, if possible.Protect the head with a pad to prevent injury to the head.Loosen the constructive clothing.Push aside any furniture that mayinjure the patient during the seizure.

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ContIf the patient becomes agitated after a seizure, use gentle restraint to assist him or her to stay calm.

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Cont.If the patient is in bed, remove pillows and raise side rails.Insert an oral airway to reduce the possibility of the patients biting the tongue or cheek.No attempt should be made to restrain the patient during the seizure ,because muscular contractions are strong and restrain can cause injury.

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Cont.If possible, place the patient on one side with head flexed forward , which allows the tongue to fall forward and facilitates drainage of saliva and mucus. If suction is available, use it if necessary to clear secretions.

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After the seizure:Keep the patient on one side to prevent aspiration. Make sure the airway is patent.There is usually a period of confusion after a grandmal seizure.A short apnoeic period may occur during or immediately after a generalised seizure.The patient, on awakening, should be reoriented to the environment.

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PHYSICAL EXAMINATION:35Vital signs, cardiopulmonary system, and neurologic status.

The neurologic examination should include neuromuscular abnormalities such as dyskinesia, dystonia, myoclonus, rigidity, and tremors.

Examination of the eyes (for pupil size and reactivity).

Abdomen (for bowel and bladder activity).

Skin (for bullae, rash, colour, warmth).

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PHYSICAL EXAMINATION

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NEUROLOGIC STATUSEYES CHECKUPVITALS CHECKUP

ABDOMINAL CHECKUP

MANAGEMENT38

39Respiratory careEndo-tracheal intubation for protection against the aspirationMechanical ventilation may be necessary for patients with respiratory depression.Continuous pulse oxi-metry use and arterial blood gas analysis.Cardiovascular careMild and moderate in severity require only observation or nonspecific sedation with a benzodiazepine.Severe cases or those associated with hemodynamic instability, chest pain specific therapy is indicated.

Administration of antidotes40SL NODRUG ANTIDOTE1.SympathomimeticsPhentolamine, propranolol2.Ergot alkaloidsNitroprusside or nitroglycerine3.AntihistaminesPhysiostigmine4.Cyclic antidepressantsHypertonic sodium bicarbonate and lidocaine5.BarbituratesHemodialysis and hemoperfusion6.OpiatesNaloxone7.IronDesferrioxamine

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THEME OF WORLD MENTAL HEALTH DAY, 2016

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