Behavioral Emergencies Chapter 33 Guillermo De La Renta

OK so… Behavior…. An individuals action or reaction in response to external or internal stimuli Can be normal or abnormal (subjective) Behavioral emergency…. A form of altered mental status Behavior abnormal within the context of the situation Variety of causes

Neurosis vs Psychosis… Neurosis Person exhibits abnormal behavior, but remains able to understand the normal boundaries of reality Ex. Anxiety Depression Paranoia agitation Psychosis Person exhibits abnormal behavior, and has altered perceptions of reality Ex. Schizophrenia Bipolar disorder

Causes of behavioral emergencies Medical disorders AMS  possible NOI Underlying issue often hypoxia, hypoglycemia Ex. Epilepsy, hypotension, diabetes… Chemical exposures Alcohol, drugs Frequent cause of BE Prescription or recreational (ex. Insulin vs. alcohol) Trauma Brain injuries cause AMS and behavioral disorders TBI  wide range of symptoms Blood loss  hypoxia in brain Hypo and hyperthermia  brain is pissed Behavioral conditions Your psyche is complex I.e. psychiatric s%&*

Signs and symptoms Agitation Paranoia Stress-laden speech Bizarre actions or thoughts Self-destructive behavior Mental confusion Hostility Uncontrolled (scream) crying

Assessment and Treatment Assessment Scene safety  BEs can escalate (0  100, real quickly) Consider possible contexts Try to notice subtle behaviors Don’t forget about basic documentation and assessment (SAMPLE, oprst, vitals…) Management Preventative Keep patient and rescuers safe Supportive Correct potential threats to life Assume behavior is from medical condition  treat accordingly

Restraint Indications When patient is endangering self or others How-to! Best done by LEO Reasonable force Ideally, minimum 5 people