Behavioral Emergencies

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					Drill of the Month
  Developed by Gloria Bizjak




Behavioral Emergencies




                               Drill of the Month
         Behavioral Emergencies
Student     Performance Objective:
Given information, resources, and opportunity for
discussion, EMTs will be able to:

•   Define behavioral emergencies
•   List causes of behavioral emergencies
•   List signs and symptoms
•   State actions and precautions for safety
•   Describe assessment and care steps

EMTs  will follow acceptable Maryland medical practice
and Maryland Medical Protocols for Emergency Medical
Providers.
                         Drill of the Month      2
Altered Mental Status: Assessing
 and Managing Seizure Patients
 Overview
 Behavioral Emergencies: Definition
 Causes of Behavioral Emergencies
 Signs and Symptoms
 Actions and Precautions
 Assessment and Care Steps



                 Drill of the Month    3
Behavioral Emergencies: Definition
   Abnormal or atypical behavior that is
    unacceptable in a given situation with the
    potential that serious harm is imminent
   Unusual and seriously alarming behavior
    – Threats to harm self, particularly suicide
    – Threats to harm others
    – Threats to cause serious property damage




                      Drill of the Month    4
Behavioral Emergencies: Definition
   Any medical/trauma situation that alters
    normal behavior and physical functioning
   NOTE:
   Consider all behavioral emergencies as
    incidents of altered mental status
   Do not overlook medical conditions
    – abnormal blood sugar level, hypoxia, stroke,
      tumor, drug or alcohol intoxication, pain,
      medications, severe infections

                      Drill of the Month    5
Causes of Behavioral Emergencies
   Trauma
    – Head injury—recent or past
        Periodic irritability
        Irrational behavior
        Confusion and frustration
        Amnesia
        Delusions



                       Drill of the Month   6
Causes of Behavioral Emergencies
   Amputation
    – Medical—losing a body part can be mentally
      traumatic
    – Traumatic—losing a body part in a crash or
      other trauma incident can be mentally
      traumatic




                      Drill of the Month    7
Causes of Behavioral Emergencies
   Medical
    – Metabolic disorders
       Hypoglycemia
       Hyperglycemia
       Endocrine, or hormonal disorders
    – Stroke
    – Epilepsy
    – History of or admission of depression


                        Drill of the Month    8
Causes of Behavioral Emergencies
   Medical
    – Hypoxia
    – Mind-altering substance use
    – Alcohol or drug abuse
    – Poison exposure or ingestion
    – Environmental
       Hypothermia
       Hyperthermia


                       Drill of the Month   9
Causes of Behavioral Emergencies
   Neurological
    – Organic brain disorder
    – Other medical conditions with organic causes
        Lesions
        Tumors
        Degenerative diseases (Alzheimer’s, Parkinson’s,
         dementia)
        Infections
        Toxins


                         Drill of the Month         10
    Causes of Behavioral Emergencies
   Stress response or any situation that causes
    prolonged, extreme stress or sever anger,
    fear, or grief
    – Loss of a loved one
    – Work/job problems or loss
    – Home/family problems
    – Money problems
    – Health problems

                       Drill of the Month   11
    Causes of Behavioral Emergencies
   Psychiatric disorders
    – History of mental illness, behavioral problems
    – Overdose of/forgetting to take psychiatric meds
    – Thought processes not logical to, or consistent
      with, situation
    – Unaware of surroundings or situation
    – Delusions or hallucinations



                       Drill of the Month     12
          Signs and Symptoms
   Observable signs
    – Body language: Expressions or actions
         Agitation—anxious, restless, panicky, nervous,
          rapid speech and movement
         Anger, aggressively hostile
         Defiance
         Violence: Threatening self, others
         Suicidal gestures or talk
         Shouting, crying out, crying
         Isolates self, refuses to talk
         Obsessive-compulsive actions

                         Drill of the Month        13
          Signs and Symptoms
   Observable signs
    – Personal appearance: Poor hygiene,
      grooming, dress
    – History of alcohol or drug abuse
    – Delusions or visions: Hears voices, may
      want to follow “orders” of voices; talks to
      unseen persons
    – Persecution: Believes others are plotting
      against him, no one understands him,
      blames others for problems
                       Drill of the Month    14
          Signs and Symptoms
   Observable signs
    – Speech or language
         Cannot talk or does not appear to understand
          what you are saying (aphasia)
         Result of brain injury (head trauma, stroke, brain
          tumor, neurological disease, epilepsy, migraine)
          to specific brain areas—NOT a cognitive disorder
          – Broca’s area—controls language/speech
          – Wernicke’s area—control language interpretation
         Talks, but word choice is unusual
          – Quality, pace, articulation

                            Drill of the Month           15
          Signs and Symptoms
   Observable signs
    – Age (with any of the above signs)
         15-25 years of age
         Over 40 years of age
         The elderly




                        Drill of the Month   16
          Signs and Symptoms
   Symptoms
    –   Possible rapid pulse rate
    –   Possible rapid breathing rate
    –   Trouble breathing
    –   Complains of headache or other pains
    –   Depression or suddenly coming out of a
        depression and feeling better



                      Drill of the Month    17
            Actions and Precautions
   General
    –   Assess the scene for dangers or safety problems
    –   Protect yourself and others
    –   Watch for changes in behavior from calm to violent
    –   Be alert for weapons or items that can be used as
        weapons
    –   Have family members, friends, others leave room or
        area if patient is agitated by their presence
           Alternately, have someone stay if that person helps calm
            patient or patient responds positively to that person
    –   Take safety actions with threat of danger
           Retreat, call law enforcement

                              Drill of the Month             18
          Actions and Precautions
   Specific
    – The suicidal patient
         Take suicidal threats seriously
         Get eye-level with patient; sit next to patient;
          maintain eye contact
         Talk to patient about thoughts and feelings; listen
         Talk to patient about previous attempts or plans




                          Drill of the Month         19
          Actions and Precautions
   Specific
    – The aggressive or hostile patient
         Ensure safety: Watch for sudden changes in
          behavior, movements, actions
         Be alert for weapons
         Call for assistance from law enforcement
         Call for medical direction if necessary




                        Drill of the Month        20
          Actions and Precautions
   Specific
    – The psychiatric patient
         Ensure safety: Watch for sudden changes in
          behavior, movements, actions
         Care for medical/trauma problems first, if possible
         Talk with the patient in a calm, reassuring voice
         Encourage conversation about problems; listen
         Use positive body language: Smile, position self at
          eye level, have hands relaxed at sides or in lap
         Do not play along with hallucinations
         Do not lie or make promises you cannot fulfill
         Involve family members if it is safe or helpful

                         Drill of the Month         21
          Actions and Precautions
   Specific
    – The patient reacting to stress
         Act calmly and take control of the situation
         Let the patient know you are there to help
         Treat the patient as an individual who has
          feelings and merit
         Do not rush the assessment or interview
         Give the patient time to interact with you




                          Drill of the Month         22
     Assessment and Care Steps
   Assessment: Perform General Patient Care
    (Refer to Maryland Protocols pp 25-34, 42)
    – Gather information on approach
    – Size up the scene
         Ensure scene safety
         Limit the number of people around the patient
         Avoid overwhelming the patient with too many
          people, too many people talking, too many sounds
         Respect the patient’s personal space



                         Drill of the Month       23
     Assessment and Care Steps
   Assessment: Perform General Patient Care
    (Refer to Maryland Protocols pp 25-34, 42)
    – Perform initial assessment to extent possible
         Mental status
          – Assess memory, concentration, judgment, orientation
          – Assess mood: facial expressions, body language, response
            to questions
         Airway, breathing, circulation
         Provide oxygen if possible
         Disability: pulse/motor/sensory
         Expose to assess injuries

                            Drill of the Month            24
     Assessment and Care Steps
   Assessment: Perform General Patient Care
    (Refer to Maryland Protocols pp 25-34, 42)
    – Perform focused history and physical exam—
      expect distorted information
       History to the extent possible: SAMPLE
         – Patient may be uncooperative
         – Patient may provide unreliable history
         – Family or caretakers may be unavailable or not
           know full history



                         Drill of the Month       25
     Assessment and Care Steps
   Assessment: Perform General Patient Care
    (Refer to Maryland Protocols pp 25-34, 42)
    – Perform focused history and physical exam—
      expect distorted information
       Physical assessment to the extent possible:
           – DCAP-BTLS
           – AEIOU-TIPS
    • Alcohol or acidosis   • Uremia
    •Epilepsy (seizures     • Trauma or tumor
    • Infection (sepsis)    • Insulin (hyperglycemia or hypoglycemia
    • Overdose              • Poisonings or psychosis
    • Uremia                • Stroke

                            Drill of the Month             26
          Assessment and Care Steps
   Assessment: Perform General Patient Care
    (Refer to Maryland Protocols pp 25-34, 42)
    – Mental assessment: AABCST
          Appearance: patient’s age, sex, hygiene, posture,
           dress (appropriate for season, situation/event,
           e.g., dressed for bed at a birthday party)
          Affect: what feelings the patient is demonstrating
          Behavior: what patient is doing
          Cognition: patient’s consciousness level, memory,
           mood
          Speech: patient’s word choice, tone, clarity,
           content, pace
          Thought processes: whether patient shows
           reasonable judgment for the situation

                              Drill of the Month      27
       Assessment and Care Steps
   Assessment: Perform General Patient Care
    (Refer to Maryland Protocols pp 25-34, 42)
    – Follow treatment protocols
    – Communicate with hospital or other response
      personnel
    – Determine priority and mode of transport and
      where




                         Drill of the Month      28
        Assessment and Care Steps
   Emergency Care      (Refer to Maryland Protocols p. 42)
    – Use restraints as necessary
       Transporting from medical facility: obtain
        physician order
       Transporting from field/home: call law
        enforcement to apply and accompany
        patient in unit




                       Drill of the Month         29
          Assessment and Care Steps
   Emergency Care         (Refer to Maryland Protocols p.
    42)
    – Use restraints as necessary
       Always use soft, humane restraints
       Have enough personnel to perform the
        restraint
           – One person for each extremity; one person for
             the head; one person to apply restraints
           – Coordinate actions
           – Be cautions of kicking, scratching, biting


                          Drill of the Month        30
       Assessment and Care Steps
   Emergency Care (Maryland Protocols p. 42)
    – Use restraints as necessary
       Restrain in a supine position, never prone
       Continuously monitor the restrained patient
        – Check breathing and pulse
        – Be alert for the struggling or agitated patient
          who suddenly becomes calm and quiet
           Check responsiveness, breathing, pulse
           Be aware of faking, attempts to attack or
             injure you

                        Drill of the Month          31
          Assessment and Care Steps
   Emergency Care (Maryland Protocols p. 42)
    – Implement SAFER model
          Stabilize situation: stop influence of sensations
          Assess and acknowledge crisis
          Facilitate/help patient understand situation; access
           resources
          Encourage use of resources and coping
          Recovery or Referral: responsible person or
           professional or transport
    – Transport/transfer/transition patient and
      information
                           Drill of the Month         32
         Behavioral Emergencies
Student   Performance Objective:
Given information, resources, and opportunity for
discussion, EMTs will be able to:

• Define behavioral emergencies
• List causes of behavioral emergencies
• List signs and symptoms
• State actions and precautions for safety
• Describe assessment and care steps


EMTs  will follow acceptable Maryland medical practice
and Maryland Medical Protocols for Emergency Medical
Providers.

                        Drill of the Month           33
           Behavioral Emergencies
 Review
 Behavioral Emergencies: Definition
    – Provide at lease one definition or description of a
      behavioral emergency
   Causes: Name at lease one behavioral emergency
    indication for each of the following
        Trauma
        Medical
        Neurological
        Stress
        Psychiatric
                           Drill of the Month          34
         Behavioral Emergencies
 Review
 Signs and symptoms
    – Name at least 5 observable signs of a
      behavioral emergency
    – What are some general symptoms of a
      behavioral emergency?




                      Drill of the Month      35
         Behavioral Emergencies
 Review
 Actions and Precautions
    – What are general actions and precautions to
      take for the behavioral emergency patient?
    – What are specific actions and precautions to
      take for each of the following situations?
       Suicidal patient
       Aggressive or hostile patient
       Psychiatric patient
       Patient reacting to stress

                          Drill of the Month   36
         Behavioral Emergencies
 Review
 Assessment and Care Steps
    – List assessment steps for the behavioral
      emergency patient
    – List the care steps for the behavioral
      emergency patient
       What are the protocols for using restraints?
       What are the steps of the SAFER model?




                          Drill of the Month           37

				
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