Module18

BehaviouralEmergencies

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BehaviouralEmergencies
OverviewonBehaviouralEmergencies
Mayoftendealwithpts.Undergoingpsychological/behaviouralcrisis Crisismaybeduetoemergencysituation/mentalillness/mindalteringsubstance/stress/manyothercauses BehaviouriswhatyoucanSEEofapersonsresponsetotheenvironment Definitionofbehaviouralcrisis/emergency o Isanyreactiontoeventsthatinterfereswithactivitiesofdailyliving(ADL) o Orhasbecomeunacceptabletopt./family/community Apersonnolongerabletorespondappropriatelytotheenvironmentmaybehavingapsychological/ psychiatricemergency Whenpsychiatricemergencyarises,pt.mayshowagitation/violence/becomeathreattothemselves/others ThisismoreseriousthantypicalbehaviouralemergencythatcausesaninterferencewithADL

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CausesofBehaviouralEmergencies
Suddengrief/emotionalconflictcancausesbehaviouralemergencies Suddenillness/recenttrauma/drugoralcoholintoxicationanddiseasedbraine.g.Alzheimersdisease HypoglycaemiacancauseAMS Twobasiccategoriesforbehavioural/psychiatricemergencies o Organicbrainsyndrome Isadysfunctionofthebraincausedbydisturbanceinthephysicalfunctioningofthebrain E.g.hypoglycaemia o Functionaldisorder Abnormaloperationoftheanorgancannotbetracedtoanobviouschangetotheactual structure E.g.schizophrenia Recognizingthedifferencemayhelptosavealife

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AssessmentofBehaviouralEmergencies
YoursafetycomesFIRST o Isthesituation/scenesafeforyouandyourpartner o Ifbackupisrequiredcallforlawenforcement Thenassesshowthepatientisrespondingtotheenvironment o Doespts.Behaviourseemnormalunderthecircumstances o Sometimespts.Maynotrespondatalltoyourquestions o Inthesecases,youcanassessmuchfromthepts.emotionalstatefromfacialexpressions,pulseand respirations Tears/sweating/blushingarealsoindicatorsofastateofmind Makesuretoassesspt.eyes o Blankgaze/rapidmovingeyesindicateCNSdepression/sometypesextrastress Whentryingtodeterminesreasonforpt.state/considerthreemajorareasascontributors o 1ispt.CNSfunctioningproperly Hypoglycaemia/poisoning/physicaltraumaallplayarole o 2arehallucinogens/otherdrugs/alcoholafactor? Doespt.seestrangethings/smellofalcoholonthebreath? o 3arepsychogeniccircumstancesinvolved(mentalratherthanphysical) Includesdeathofalovedone/historyofmentalillness/suicidethreats

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Suicide
Singlemostcontributingfactortosuicideisdepression ThreateningSuicidemaybeacryforhelp Threateningsuicideisindicationthatsomeoneisincrisisthattheycannothandle o Immediateinterventionisnecessary

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Module18 1.5

BehaviouralEmergencies

WarningSigns
Airoftearfulness/sadness/deepdespair/hopelessnessthatsuggestdepression Avoidingeyecontact/speakingslowly/projectingsenseofvacancy Unabletotalkaboutfuture/futureissodistanttheydontthinkaboutit Anysuggestions/includevaguesuggestionaboutsuicide(donottakelightly)

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Medicolegalconsiderations
Mentalincapacitycantakemanyforms: o Hypoxia o Alcohol o Drugs o Stress o Depression Onceyouhavedeterminedthept.hasimpairedmentalcapacity,youmustdecideifthept.needsemergency medicalcare Apt.thatismentallyunstablemayresistyourattemptstoprovidecare Donotleavethesepts.alone,youmayexposeyourselftoabandonmentornegligence Obtainlawenforcementassistanceifneeded

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Consents
Whenapt.isnotmentallycompetent,lawassumesthereisimpliedconsent Incaseofpsychiatricemergencies o Thematterisnotalwaysclearcut o Doesalifethreateningemergencyexistornot o Ifindoubtcallyourmedicalofficer/lawenforcementassistance

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Limitedlegalauthority
Generalruleoflaw: o Acompetentadulthastherighttorefusetreatment/transport,eveniflifesavingcareisinvolved o Providedtheycanmakeinformeddecisions Inpsychiatriccases o Aparent/guardian/childorclosefamilywouldprobablyconsideryouractionsinprovidinglife savingcaretobeappropriate o Especiallyifyoubelievethatthept.wouldharmthemself

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Restraint
YouMAYNOTrestraintapt.WITHOUTauthority o Ifyoudo,youmaybeexposedtoalawsuitincludingchargesof: Assault Battery Falseimprisonmentand Violationofcivilrights Youmayonlyusereasonableforcetocontrolyourpt. o YoushouldconsultyouALSbeforerestrainingyourpt. YoumayONLYuserestraintsto: o Protectyourself o Protectothers o Andthept.fromharmingthemselves Alwaystrytransportadisturbedpt.withoutrestraintsifpossible Oncedecisionhasbeenmadetorestrainpt.mustbecarriedoutquickly Makesureyouhaveadequatehelptorestrainthept.safely o Howeveronly5peopleareallowed BeawareofBSI:Ifapt.isspitting,placeanoxygenmaskoverpt.faceetc. Treatpt.withdignityandremembertomonitorpt.forvomitingairwayobstructionandcardiovascularstability o Pt.cantfendforhimself

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Module18 1.10 ViolentPatients

BehaviouralEmergencies

Thefollowingmaybeusedtoassessthelevelofdanger: o Pasthistory: Previousviolence/aggressivebehaviour o Posture Howaretheystanding/sitting Aretheytense,rigid,sittingonedge o Thescene Isthept.holding/nearapotentiallylethalweapon o Vocalactivity Loud/obscene/bizarrespeechindicatesemotionalstress Pt.usingquite/orderedspeechislesslikelytostrikeout o Physicalactivity Lookfortensemuscles/clenchfists/glaringeyes/excessivepacing

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