Behavioral Emergencies

Behavior Defined as the manner in which a person acts or performsDefined as the manner in which a person acts or performs

Behavioral Emergency Exists when a person exhibits abnormal behaviorExists when a person exhibits abnormal behavior Behavior that is unacceptable or intolerable to the patient, the family, or the communityBehavior that is unacceptable or intolerable to the patient, the family, or the community

Physical Causes Low blood sugarLow blood sugar Lack of oxygenLack of oxygen Inadequate blood to the brainInadequate blood to the brain Head TraumaHead Trauma Mind-altering substancesMind-altering substances Excessive coldExcessive cold Excessive heatExcessive heat ALWAYS consider that unusual behavior is caused by something other than a psychological problemALWAYS consider that unusual behavior is caused by something other than a psychological problem

Situational Stress Reactions Severe, unexpected stress will cause patients to display fear, grief, and angerSevere, unexpected stress will cause patients to display fear, grief, and anger Apply crisis management skillsApply crisis management skills Do not rush your patientDo not rush your patient Reassure them that you are there to helpReassure them that you are there to help

Psychiatric Emergency Signs and SymptomsSigns and Symptoms –Panic or anxiety –Unusual appearance, disordered clothing, poor hygiene –Agitated or unusual activity –Unusual speech patterns –Bizarre behavior or thought patterns –Suicidal or self-destructive behavior –Violent or aggressive behavior

Patient Care Be alert – Safety first!Be alert – Safety first! Treat any life-threatening problemsTreat any life-threatening problems Be prepared to spend time talking with the patientBe prepared to spend time talking with the patient Encourage the patient to discuss the problemEncourage the patient to discuss the problem NEVER play along with visual or auditory hallucinationsNEVER play along with visual or auditory hallucinations Involve family members or friends, IF it helpsInvolve family members or friends, IF it helps

Suicide 8 th leading cause of death8 th leading cause of death 3 rd leading cause of death in 15-to 24-year olds3 rd leading cause of death in 15-to 24-year olds Many reasons and methodsMany reasons and methods

Suicide Assessment Factors that indicate a high risk for suicidal behavior:Factors that indicate a high risk for suicidal behavior: –Depression –High stress levels –Recent emotional trauma –Age –Alcohol and drug abuse –Threats of suicide –Suicide plan –Previous attempts or threats –Sudden improvement form depression

Suicide Patient Care Treatment must begin with scene size-up – safety first!Treatment must begin with scene size-up – safety first! Treat life-threatening problemsTreat life-threatening problems –Seek police assistance if necessary Perform focused history and physical examPerform focused history and physical exam Detailed physical examDetailed physical exam –ONLY if safe and the pt has a suspected injury Ongoing assessment – watch for sudden changesOngoing assessment – watch for sudden changes Contact receiving hospitalContact receiving hospital

Aggressive/Hostile Patients Your assessment may never go beyond initial assessmentYour assessment may never go beyond initial assessment Can be caused by various medical conditionsCan be caused by various medical conditions –Ex. Metabolic disorders, trauma to the brain, stress

Aggressive Patient The aggressive patient will:The aggressive patient will: –Respond to people inappropriately –Try to hurt himself or others –Possibly have a rapid pulse and breathing –Display rapid speech and rapid physical movements –Appear anxious or nervous

Patient Care Safety first!Safety first! Seek advice from medical direction if behavior prevents further assessmentSeek advice from medical direction if behavior prevents further assessment Watch for sudden changes in behaviorWatch for sudden changes in behavior Seek assistance from law enforcementSeek assistance from law enforcement

Reasonable Force Always use reasonable amount of forceAlways use reasonable amount of force If restraints are used, be cautious of positional asphyxiaIf restraints are used, be cautious of positional asphyxia