Download AEMT Transition - Unit 22

TRANSITION SERIES
Topics for the Advanced EMT
CHAPTER
22
Psychiatric Disorders
Objectives
• Review the frequency of psychiatric
disorders.
• Understand the basic pathophysiology
of psychiatric disorders.
• Discuss assessment and strategies for
managing a patient with a psychiatric
disorder.
Introduction
• Mental disorders affect cognition,
emotion, mood, or behavior.
• A wide display of symptoms or
behaviors can be seen with psych
patients.
• Generally, these patients need extra
time and care regarding
communication.
Epidemiology
• Mental disorders affect an estimated 1
in 4 adults a year.
• Leading cause of disability in 15-44 age
bracket.
• Responsible for more than 6% of
emergency department visits.
Pathophysiology
• No real known cause for psych
problems
– Thought to be interaction of multiple
factors.
– First task is to rule out any non-psych
reason for the change in behavior.
 Medical conditions
 Traumatic injuries
Pathophysiology
• No real known cause for psych
problems
– Treatment commonly a combination of
drugs, counseling, and group therapies.
Pathophysiology (cont’d)
• Types of psychiatric disorders
– Psychosis and schizophrenia
– Mood disorders
– Anxiety disorders
– Somatoform disorders
Pathophysiology (cont’d)
• Types of psychiatric disorders
(continued)
– Factitious disorders
– Dissociative disorders
– Sexual and gender identity disorders
– Eating disorders
Pathophysiology (cont’d)
• Types of psychiatric disorders
(continued)
– Impulse control disorders
– Personality disorders
– Attention deficit hyperactivity disorders
– Autism spectrum disorders
– Substance related disorders
– Alzheimer’s disease
– Suicide
Assessment
• Be sure to rule out medical/traumatic
causes for alterations.
• Signs and symptoms will vary for each
individual and each situation.
The patient with a mental disorder will require additional communication
skills, patience, and compassion. Touch may be comforting to some patients,
but do not touch a patient without the patient’s consent.
Assessment (cont’d)
• Consider the following approach with
psych patients:
– Gain consent for treatment.
 Determine mental status first.
– Assess mental status of the patient.
 Note mood, posture, dress, grooming,
etc.
Assessment (cont’d)
• Consider the following approach with
psych patients:
– Conduct the verbal interview.
 Note suicidal or homicidal ideations,
hallucinations, delusions, phobias, etc.
Restraint and Patient Safety
• Core principle is to do no harm.
• EMS should not be in direct contact
with a violent patient.
• In many systems the police are
responsible for providing restraint.
• When assisting with restraint, follow
proper application principles.
Agitated Delirium
• Condition that leads to the death of a
patient with an apparent psychiatric
emergency.
• Patients often present with psychosis,
hallucinations, and “superhuman
strength.”
• Behavior ceases rapidly with the onset
of respiratory/cardiac arrest.
Emergency Medical Care
• Safety of the provider is paramount.
• Assess the patient for trauma or
medical conditions (treat if found).
• Use restraints based on protocol.
• Provide supportive environment for the
patient to receive care.
• Transport the patient to an appropriate
facility.
Case Study
• Your EMS unit is dispatched for a
patient with a psychological problem.
The address is for a local group home
in your community. Upon your arrival,
you see a patient standing in the corner
of the porch, his hands covering his
face. He is surrounded by others you
assume to also live at the home.
Case Study (cont’d)
• Scene Size-Up
– Standard precautions taken.
– Group of people standing around the
assumed patient.
– You hear some yelling as you start to
approach.
Case Study (cont’d)
• Scene Size-Up (continued)
– The unconfirmed NOI is for a psych
emergency.
– Entry and egress from porch will be
easy once the small crowd disperses.
• What are some concerns you have
based on the scene size-up?
Case Study (cont’d)
• Primary Assessment Findings
– Scene is secured by PD.
– The patient is still standing, muttering
something you can't understand.
– Airway, breathing, and circulation seem
intact based on the patient's ability to
stand and vocalize.
– As you approach the patient for
examination, he starts yelling at you.
Case Study (cont’d)
• Is this patient a high or low priority?
Why?
• What are the life threats to this
patient?
• What emergency care should you
provide based on the primary
assessment findings?
Case Study (cont’d)
• After a brief while, the patient finally
trusts you enough to allow you to
approach him. Although you ask him
specific questions about how he feels,
he just keeps repeating, “The ants are
crawling all over me,” despite the fact
that there are no ants anywhere to be
seen.
Case Study (cont’d)
• Medical History
– Unknown
• Medications
– Unknown
• Allergies
– Unknown
Case Study (cont’d)
• Pertinent Secondary Assessment
Findings
– Pupils midsize and midposition.
– Airway clear and breathing normal.
– Membranes pink and hydrated.
– Breath sounds equal bilaterally.
– Patient does not express any areas of
pain on his body.
Case Study (cont’d)
• Pertinent Secondary Assessment
Findings (continued)
– Vitals are within normal limits.
– Patient still insists there are ants
crawling all over him.
– BGL 102 mg/dL, pulse ox is 99% on
room air.
Case Study (cont’d)
• What is your field impression at this
time?
• What would be the next steps in
management you would provide to the
patient?
Case Study (cont’d)
• Care provided:
– Patient placed on the cot in semi-Fowler
position.
– Pulse ox maintained en route (99%100%).
– Patient verbally reassured and reassessed
en route to ED.
– As a precaution, your partner calls ahead
to the ED to have security standing by.