ER 1 > Psych > Flashcards

Psych Flashcards

(22 cards)

Study These Flashcards
1
Q

Initial Labs for psych pt

A
  • CBC: infection, anemia
  • CMP
  • Urine drug screen
  • UA
  • Urine tricyclics: false + common
  • EtOH
  • Acetaminophen level
  • Salicylate level
  • Other med levels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Other initial tests for psych pt

A
  • EKG: >60 yo, cardiac hx, OD suspected, tested + for cocaine, PCP, meth, tricyclics
  • CXR: >60 or hypoxic
  • CK: ensure not in rhabdo, acutely psychotic expend a lot of E
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is really important to get before police, EMS, family leave?

A

Third party statement

- gives reason to constrain, confine, EOD a pt against their will

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

EOD in OK

A

Emergency order of detention

  • 72 hours
  • not including weekends or holidays
  • > 72 hr must get judge order
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Management of acutely psychotic/agitated pt

- Safe evaluation of the pt

A
  • remove dangerous items from room and self
  • observe from distance first
  • control own emotion/fear
  • Enter room in non-threatening manner, keep 2-arm distance, don’t stare
  • est rapport
  • call for help if needed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Management of acutely psychotic/agitated pt

- desescalation

A
  • Respect personal space: 2 arm lengths
  • Don’t provocative: open hands, open body language
  • Verbal contact: only one person talks to pt
  • Concise: simple, repeat helpful info often
  • ID needs, wants, feelings
  • Actively listen to pt
  • Agree or agree to disagree: “yes, but…” to avoid saying no all the time
  • Lay down the law and set limits, coach pt how to stay in control
  • Offer choices and optimism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Management of acutely psychotic/agitated pt

- Escalation failed :(

A
  • warn pt that aggression will = restraints
  • outnumber with staff
  • have restraints ready (physical and chemical)
  • monitor pt vitals and restraint sites
  • Remove restraints as soon as possible
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Types of restraints

A
  • soft: MC, 4 point (wrists and ankles)
  • leather: extreme violent/physicaly powerful pts
  • reverse trendelenburg in bed
  • one arm up, one arm down so they can’t “squirrel out”
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Chemical sedation

- overview

A
  • can help calm pt and keep staff safe

- unintended consequences: increased length of stay, ADR to meds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Chemical sedation

- 3 main options

A
  1. Benzos (Ativan): ADR - sedation, hypotension, resp. depression
  2. 1st Gen Antipsychotics (Haldol): ADR- sedation, Prolonged QT, extrapyramidal sx, neuroleptic malignant syndrome
  3. Atypical Antipsychotics (Zyprexa, Geodon): ADR - extrapyramidal sx, neuro malig syndrome, hypotension. Geodon: prolonged QT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Chemical sedation and special populations

A
  • elderly: lower dose
  • Seizure hx: antipsychotics lower seizure threshold… use benzos
  • Peds/adolesecents: lower IM doses, use diff drugs
  • Acute withdrawal: use benzos
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Suicidal Ideation

A
  • MC presentation
  • Post a guard or sitter to keep safe, make sure nothing on them or in room they can use to harm themselves
  • Evaluate threat, do they have a plan?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Suicide attempt

- first step

A
  • figure out how:
  • hanging, cut, GSW, OD, MVA
  • teen-30 yo males most likely to complete suicide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

OD

A
  • pumping stomach not done
  • call poison control, esp household products
  • Insulin OD: ICU
  • HTN meds, colchicine, insulin: dangerous
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Manic behavior

A
  • Most people with bipolar live nl life

- mania can be induced by stress: drugs/etoh, fam problems, med non-compliance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Anxiety

Study These Flashcards
A
  • can present as chest pain, shaking, visual disturbances
  • Some need reassurance, referral to out pt
  • Some need meds, avoid benzos. Hydroxazine is good stop-gap option
17
Q

Panic Attack

Study These Flashcards
A
  • somatic sx: SOB, tachycardia, diaphoresis, HA, n/v, shaking
  • Focus on breathing, no paper sack tx
  • Benzos ot treat
  • ensure medically stable
18
Q

Drugs and alcohol

Study These Flashcards
A
  • Seek tx
  • Seek relief from withdrawal sx
  • Can become hopeless/suicidal when don’t quality for tx
19
Q

Drug and alcohol withdrawal

Study These Flashcards
A
  • Can be dangerous, can just suck
  • N/v, HA, myalgia, tremors
  • Suck: opioids, meth, THC, cocaine. Complication is rhabdo, keep hydrated
    Seizure risk: benson and alcohol
  • Tx Sx: fluids, antiemetics
20
Q

etoh withdrawal

Study These Flashcards
A
  • Delirium tremens: 24-72 hrs since last drink
  • Tremor, confusion, hallucinations, dehydration, seizures
  • Tx: IV fluid, IV ativan, thiamine, multivitamin w/folic acid
  • CIWA-AR score
21
Q

Emergency psych overall goals:

Study These Flashcards
A

Ensure:

  • Medically stable
  • Not a danger to self or others
  • Get to appropriate care, inpt or outpt
22
Q

Peds Psych

Study These Flashcards
A
  • 3% of ED visits
  • Unstable families, abuse, fam hx mental illness
  • MC: aggression and SI
  • be careful using drugs, most not studied in kids
  • Call DHS is concerned
ER 1
flashcards
Decks in class (18)
# Cards
Brainscape helps you reach your goals faster, through stronger study habits.
© 2026 Bold Learning Solutions. Terms and Conditions