Understanding Behavioral Health Emergencies and Responses
School
Gyeongnam National University of Science and Technology**We aren't endorsed by this school
Course
CHEM 14A
Subject
Nursing
Date
Dec 11, 2024
Pages
76
Uploaded by PresidentSeaUrchinMaster571
Toxicology, Behavioral Health Emergencies, and Therapeutic CommunicationsSession 14Chapter 22 and 23
Why do we matter?
Definitions●Behavior - how a person functions or acts in response to their environment●Behavioral crisis - the point at which a person’s reactions to events interfere with daily living●Activities of daily living - basic action a person normally accomplishes; eating, bathing, dressing●Behavioral health emergency - a situation in which abnormal behavior threatens the health or safety of themselves or others
Definitions●Psychiatric disorder - illness with behavioral symptoms caused by social, psychological, genetic, physical, chemical, or biological disturbance○Can be organic (physical) or functional (psychological)●Organic brain syndrome - dysfunction of the brain caused by physical or physiologic functioning of the brain tissue○Traumatic brain injury, seizure disorder, overdose, diseases of the brain●Functional disorder - physiological disorder that impairs bodily function when the body is structurally intact○Schizophrenia, anxiety, depression
Behavioral Health Emergencies●Acute psychosis●Schizophrenia●Delirium●Hyperactive delirium syndrome●Bipolar disorder●Major depressive disorder ●Suicide●Posttraumatic stress disorder
Acute Psychosis●State of delusion in which the person is out of touch with reality●This may be their reality, they are experiencing it●Is there an underlying cause
Schizophrenia (DSM-5 Criteria)●Abnormalities in one of the following○Delusions○Disorganized thinking○Grossly disorganized motor behavior○Hallucinations○Negative symptoms - diminished emotional expression or avolition ■Decrease in motivated self initiation, purposeful activities
Schizophrenia●Typical onset 16 - 30 years old○Following a stressful event○Genetic or social influence●Assess for medications and medical history●Treatment○Ensure safety for you and the patient○Therapeutic communication○Involve family
Delirium●A condition of impairment in cognitive function that can be present with disorientation, hallucinations, or delusions●A disturbance in attention or awareness●Develops over a short time period●Usually reversible
Hyperactive Delirium Syndrome (Excited Delirium)●Hyperactive irrational behavior with vivid hallucinations●Potential for violent behavior●Signs and Symptoms○Hyperactivity, disconnection with reality○Hypertension, tachycardia○Hyperthermia○Diaphoresis
Hyperactive Delirium Syndrome (Excited Delirium)●Treatment○ALS and law enforcement○Chemical sedation○Restraints●Positional asphyxia - physical position restricts chest movement leading to impaired airway and breathing
Hyperactive Delirium Syndrome (Excited Delirium)
Bipolar Disorder●Bipolar disorder (formerly called manic-depressive illness) is a disorder that causes unusual shifts in mood, energy, activity levels, concentration and the ability to carry out day to day tasks●Fluctuations of mania and depression●Mania - elevated or excited behavior, increase in mood and activity level
Major Depressive Disorder●There are other types of depression and they are common for EMS●There is not always an underlying diagnosis
Suicide●The most significant factor that contributes to suicide is depression●“Attempted suicide”●“Completed suicide”●Risk factors○Feeling of helplessness and hopelessness○Previous suicide attempt○Specific plan for suicide○Recent life change○Withdraw from family, social support resulting in isolation○Previous behavioral health disorder
Post Traumatic Stress Disorder●Exposure to actual or threatened death, serious injury, or sexual violence in one of the following ways○Directly experiencing the event○Witnessing, in person, the event○Learning that the event occurred to a close friend or family member○Experiencing repeated or extreme exposure to aversive details of the event
Post Traumatic Stress Disorder●Signs and Symptoms○Recurrent, involuntary, and intrusive memories of the event○Recurrent, distressed dreams ○Flashbacks○Prolonged psychological distress, 30+ days○Physiological response
Use of Restraints●Restraints are attached to each extremity and the ambulance stretcher●Monitor the patient closely for changes in the primary assessment●Continue to reassess CMS in all restrained extremities, every 5 minutes●Documentation of need and response
Medicolegal Considerations●Consent: expressed, implied, involuntary●Is there a life-threatening emergency●Is there an obvious danger to self or others●Discuss with medical control●Involve law enforcement or behavioral health●5150/5585 psychiatric hold (72 hour hold)
Poll QuestionWhich of the following symptoms are most strongly associated with psychosis? Select the two correct answer options.1.Anxiety2.Delusions3.Flashbacks4.Hallucinations5.Decreased appetite
Poll QuestionWhich of the following symptoms are most strongly associated with psychosis? Select the two correct answer options.1.Anxiety2.Delusions - false beliefs 3.Flashbacks4.Hallucinations - sensory abnormalities 5.Decreased appetite
Positive PsychologyHealth is “a state of complete physical, mental, and social well-being, and not just the absence of disease.” - World Health OrganizationMartin SeligmanMihaly Csikszentmihalyi●Hedonia/Eudaimonia●Values ●Character Strengths●Flow ●Meaning●Gratitude●Motivation
Toxicology
Definitions●Toxicology - study of toxic or poisonous substances ●Toxin - a poisonous substance produced by bacteria, animals, or plants, that changes the normal metabolism of cells ●Poison - any substance whose chemical action can damage body structures or impair body function●Substance abuse - the misuse of any substance to produce a desired effect
Definitions●Overdose - a person taking a toxic or lethal dose of a drug●Antidote - a substance that will counteract the effects of the particular poison●Toxidrome - a syndrome caused by a dangerous level of toxins in the body
ToxicologyFour avenues to consider:●Inhalation●Absorption●Ingestion●Injection
Inhaled Toxins●Natural gas●Pesticides●Carbon monoxide●Chlorine●Move the patient into fresh air immediately●Use self-contained breathing apparatus to protect yourself from poisonous fumes●Decontaminate the patient by removing clothing, copious water●Provide oxygen if shortness of breath is present●Take containers, bottles, labels with patient
Absorbed Toxins●Acids (vinegar)●Alkalis (bleach, lye)●Hydrocarbons●Poison oak●Distinguish between contact burns and absorption
Absorbed Toxins●Signs and symptoms○Burns○Itching○Irritation○Typical odors of the substance●Contact dermatitis○Red, itchy rash caused by direct contact with a toxin or allergen
Treatment●Avoid contaminating yourself or others●Brush solid contents off the patient○Then flush with copious amounts of water (15 - 20 min)●Obtain material safety data sheets (MSDS)
Eye Exposure●Irrigate for 15 - 20 minutes with copious amounts of water
Ingested Toxins●About 80% of poisonings are by mouth●Drugs●Liquids●Household cleaners●Contaminated food●Plants
Ingested Toxins●Signs and symptoms vary greatly with the:○Type of poison○Age of the patient○Time that has passed since ingestion●Treatment○Treat for life threats
Activated Charcoal
Injected Toxins
Injected Toxins●Signs and symptoms vary greatly based on the substance○Weakness○Dizziness○Fever/chills○Unresponsiveness○Excitability●Absorbs quickly into the body●Treatment:○Life threats
Poll QuestionPlace the following toxic exposure pathways in order from fastest to slowest effect. 1.Injected2.Absorbed3.Ingested4.InhaledAnswer options: A.1, 4, 2, 3B.1, 2, 4, 3C.2, 3, 1, 4 D.4, 2, 3, 1
Poll QuestionPlace the following toxic exposure pathways in order from fastest to slowest effect. Answer options: A.1, 4, 2, 3B.1, 2, 4, 3C.2, 3, 1, 4 D.4, 2, 3, 11. Injected4. Inhaled2. Absorbed3. Ingested
Patient AssessmentScene Size Up○Is there an unpleasant or odd odor?○Do I see anything suggesting an exposure?○Are there medication bottles lying around?○Are there alcoholic beverage containers?○Are there syringes or drug paraphernalia?
Patient AssessmentSAMPLE history○What is the substance involved?○When did the patient become exposed to it?○What was the level of exposure?○How much does the patient weigh?
Treatment●Supporting the ABCs is your most important task●Oxygen if shortness of breath is present●Consider activated charcoal for ingestions●Consider contacting medical control or a poison center to discuss treatment options
Group ActivityPublic Health Flyer Creation 15 minutesYour group will be assigned a specific toxin to make a public health flyer for. This flyer should include what the toxin is, the signs and symptoms of ingestion, the dangers of the toxin, and potential solutions to those dangers if they exist. Please include references on the second page! At the end of your 15 min: Your group must have a completed flyer and select one member who will briefly present to the class.
Resume Recording
Group ActivityPublic Health Flyer Creation PresentationsOne member from each group will briefly present their group’s completed flyer to the class.
Specific Toxins●Alcohol●Opioids●Sedative/hypnotics●Abused inhalants●Sympathomimetics●Cocaine●Cannabis●Hallucinogens●Cholinergics●Anticholinergics●Food poisoning●Plant poisonings
Alcohol●Alcohol is a powerful CNS depressant○Decreases activity and excitement (sedative)○Dulls the sense of awareness, slows reflexes, and reduces reaction time (hypnotic)●If a patient exhibits signs of serious CNS depression, you must provide respiratory support●Patients may experience frightening hallucinations, or delirium tremens (DTs)
Delirium Tremens●Occurs from alcohol withdrawal●Occurs 1 - 7 days following decrease intakeSigns and Symptoms○Delusions and/or hallucinations○Agitation and restlessness○Fever○Sweating○Tremors○Confusion and/or disorientation○Seizures
Opioids●Narcotic - a drug that produces sleep or altered mental consciousness●Opioid- a type of narcotic medication used to relieve pain
OpioidsSigns and Symptoms○ALOC, lethargy○Respiratory depression/arrest○Constricted pupils (pinpoint pupils)○ Hypotension○Nausea & vomiting○Cyanosis secondary to respiratory depression
Narcan (Naloxone)
Sedative-Hypnotic / CNS Depressants ●Barbiturates and benzodiazepines○Commonly prescribed○Easy to obtain and relatively cheap●Generally taken by mouthSigns and Symptoms○ ALOC○Respiratory depression/hypoxia○ Ataxia○Slurred speech○ Bradycardia○ Hypotension○ Amnesia
Sedative-Hypnotic / CNS Depressants
Abused Inhaled ●Same CNS effects but inhaled●Acetone, toluene, xylene, hexane●Found in glues, cleaning compounds, compressed gas cans●Gasoline and halogenated hydrocarbons are also abused●Use a stretcher to move the patient, give oxygen, and transport to the hospital
Sympathomimetics●Mimic the effects of the sympathetic (fight-or-flight) nervous system●Produces an excited state (stimulant)●Frequently cause hypertension, tachycardia, and dilated pupils●Designer drugs are frequently abused in certain areas of the United States
Sympathomimetics
Cocaine●Cocaine may be taken in a number of different ways●Can be absorbed through all mucous membranes and even across the skin●Acute overdose is a genuine emergency●Severe agitation can lead to tachycardia and hypertension●Do not leave the patient unattended●Provide prompt transport
Cannabis●Produces euphoria, relaxation, and drowsiness●Impairs short-term memory and the capacity to do complex thinking●Could progress to depression and confusion●Concern with mixing drugs with other substances
Hallucinogens●Cause visual hallucinations●Intensify vision and hearing●Generally separate the user from reality●Patients experiencing a “bad trip” will be hypertensive, tachycardic, anxious, and paranoid.
Cholinergics - Pesticides and Nerve Agents●Overstimulate the parasympathetic system●Organophosphates○Pesticides, fertilizers●Nerve gas○Sarin○VX, GX
Cholinergic - ParasympatheticDUMBBELLS●Defecation●Urination●Miosis●Bronchorrhea●Emesis●Lacrimation●SalivationSLUDGEM●Salivation●Lacrimation●Urination●Defecation●Gastrointestinal irritation●Emesis●Miosis (pinpoint pupils)
Treatment●The most important consideration is to avoid exposure●Decontamination may take priority over immediate transport●After decontamination:○Decrease the secretions in the mouth and trachea○Provide airway support
DuoDote Kit●DuoDote Auto-Injector kit○The kit consists of an auto-injector of atropine and one of 2-PAM chloride.○Indications include a known exposure to nerve agents or organophosphates with manifestation of signs and symptoms○Can be peer administered
Plant Poisoning●It is impossible to memorize every plant or poison, let alone their effects●Notify the regional poison center●Take a photo of the plant
Medical Exam●75 questions●75 minutes●Chapters: 15 - 24●Cut score: 72%○Study guide○Exam review○Study grids○TestPrep
Questions?