Chapter 24 Behavioral Emergencies PDF

scenario  45/ f patient, her neighbors called police and EMS to check on the woman because they haven't seen her since three days. She has recently widowed and her neighbors report that she has been very depressed, when you go her home you saw her like this....

scenario  45/ f patient, her neighbors called police and EMS to check on the woman because they haven't seen her since three days. She has recently widowed and her neighbors report that she has been very depressed, when you go her home you saw her like this. Slide 0 patient Slide 1 What will you do? Slide 2 Chapter 24 Behavioral Emergencies Slide 3 Overview  Behavior  Behavior Changes  Psychological Crises  Suicidal Gestures  Assessment and Emergency Care  Scene Size-Up  Communication and Emergency Medical Care  Calming the Patient  Restraints  Medical and Legal Considerations  Consent  Resistance to Treatment  Use of Force  Documentation Slide 4 Behavior  Behavior is the manner in which a person acts or performs  All physical and mental activities are part of a person’s behavior  Many factors can influence a person’s behavior, including cultural norms, stress levels, and psychological makeup Slide 5 Behavior  Behavioral emergency  Results when a person exhibits abnormal behavior in a situation that results in potential harm to himself or others  Behavior is unacceptable or intolerable to the person, family members, or the community Slide 6 Behavior  Conditions that affect behavior  Low blood sugar  Mind-altering substances  Lack of oxygen  Psychogenic—resulting in  Inadequate blood flow psychotic thinking, to the brain depression, or panic  Head trauma  Excessive cold  Excessive heat Slide 7 Psychological Crisis  Psychological crises  Panic  Agitation  Bizarre thinking and behavior  Paranoia- patient thinks somebody is plotting against him.  Manic- agitated, moving and speaking rapidly.  Depressed- may not want to move or answer any question.  Danger to self  Self-destructive behavior  Suicide  Danger to others  Threatening behavior  Violence Slide 8 Suicidal Gestures  Thoughts of death or taking one’s life The EMT-Basic must recognize and intervene in self- destructive behavior before the patient commits the act of suicide. Slide 9 Suicidal Gestures  Risk factors  Individuals older than 40 years  Single  Widowed or divorced  Alcoholic  Depressed  A defined, lethal plan of action that has been verbalized  Unusual gathering of articles that can cause death Slide 10 Suicidal Gestures  Risk factors  Previous history of self-destructive behavior  Recent diagnosis of serious illness  Recent loss of significant loved one  Arrest or imprisonment  Loss of job Slide 11 Review questions  Define the word behavior?  Which of the following are considered risk factors for suicide? A. Divorce B. Recovery from recent illness C. Previous destructive behavior D. Recently widowed  A behavioral emergency exists when the person acts in a _______ manner that may be a threat to himself or herself or others. Slide 12 Assessment and Emergency Care Slide 13 Assessment and Emergency Care  Scene Size-Up  Patient in an unsafe environment or with unsafe objects in hands  Displaying of self-destructive behavior during initial assessment or prior to emergency response Any object may become dangerous if the person holding it intends to do harm. Slide 14 Signs of potential violence  Sitting on the edge of the seat as if ready to move.  Clenched fists.  Yelling and using profanity.  Standing or moving towards the emt.  Throwing things.  Holding onto a potentially dangerous object.  Any behavior that makes the EMT uneasy. Slide 15 Assessment and Emergency Care  Focused history and physical exam  Important questions to be considered  How does the patient feel?  Does patient have suicidal tendencies?  Is patient a threat to self or others?  Is there a medical problem? Have any interventions been initiated? Slide 16 Assessment and Emergency Care  Assessment of potential violence  History  Check with family and bystanders to determine if the patient has a known history of aggression or combativeness  Posture  Stands or sits in a position that threatens self or others  May have fists clenched or lethal objects in hands  Vocal activity  Yelling or verbally threatens harm to self or others  Physical activity  Moves toward caregiver, carries heavy or threatening objects, has quick irregular movements, muscles tense Slide 17 Assessment and Emergency Care  Do not allow any participant in a dispute to position himself between you and an exit Slide 18 Communication and Emergency Care Slide 19 Communication and Emergency Care  Scene size-up, personal safety  Patient assessment  Calm the patient  Do not leave the patient alone  Restrain if necessary  Consider need for law enforcement  Transport Slide 20  Communication and Emergency Care  Principles for assessing behavioral emergency patients  Identify yourself and let the person know you are there to help  Inform him or her of what you are doing  Ask questions in a calm, reassuring voice  Allow the patient to tell what happened without being judgmental  Show you are listening by rephrasing or repeating part of what is said  Acknowledge the patient’s feelings Slide 21 Communication and Emergency Care  Assess the patient’s mental status  Appearance  Activity  Speech  Orientation for time, person, and place  If overdose, bring medications or drugs found to medical facility Slide 22 Calming the Patient Slide 23 Calming the Patient  Maintain a comfortable distance  Encourage the patient to state what is troubling him or her  Do not make quick moves  Respond honestly to patient’s questions  Do not threaten, challenge, or argue with disturbed patients  Tell the truth; do not lie to the patient  Do not “play along” with visual or auditory disturbances of the patient  Involve trusted family members or friends  Be prepared to stay at the scene for a long time; always remain with the patient  Avoid unnecessary physical contact; call additional help if needed  Use good eye contact Slide 24 Restraints Slide 25 Restraints  Restraint should be avoided unless patient is a danger to self and others  When using restraints have police present, if possible, and get approval from medical direction Slide 26 Restraints  Examples of soft restraints Slide 27 Restraints  Technique  Be sure to have adequate help  Plan your activities  Use only the force necessary for restraint  Estimate range of motion of patient’s arms and legs and stay beyond range until ready  Once decision has been made, act quickly Slide 28 Restraints  Technique  Have one EMT-Basic talk to patient throughout restraining  Approach with four persons, one assigned to each limb, all at the same time  Secure limbs together with equipment approved by medical direction  Secure to stretcher with multiple straps Slide 29 Restraints Slide 30 Restraints Slide 31 Restraints  Technique  Cover face with surgical mask if patient is spitting on EMT-Basics  Reassess circulation frequently  Document indication for restraining patients and technique of restraint  Avoid unnecessary force Slide 32 Medicolegal Considerations  Consent  Determine if patient is capable of making decisions  Obtain consent if possible  Emotionally disturbed patient who consents to care—legal problems greatly reduced Slide 33 Medicolegal Considerations  Resistance to treatment  Emotionally disturbed patient will often resist treatment  May threaten EMT-Basics and others  To provide care against patient’s will, you must show reasonable belief the patient would harm self or others  If a threat to self or others, patient may be transported without consent after contacting medical direction  Usually law enforcement is required Slide 34 Summary  Behavior  Behavior Changes  Psychological Crises  Suicidal Gestures  Assessment and Emergency Care  Scene Size-Up  Communication and Emergency Medical Care  Calming the Patient  Restraints  Medical and Legal Considerations  Consent  Resistance to Treatment  Use of Force  Documentation Slide 35