EMT Basic Chapter 23,24

depression

- highest rate of suicide - persistent feeling of sadness and despair symptom of underlying health disorder

forcible retraint

- conronted with patient who needs care and transport but is combative and dangerous - ask for other services and family to restrain them before treating as it can lead to legal issues - verbal deescalation before physical restraint

fowler

- used to breathe easier and control airway - semi reclining position - prevents aspiration and reduces physical exertion by relaxing abdominal muscles

delirium

- symptom -> temporary state that often has a physical or mental cause and can be reverse with proper treatment - impairment in cognitive function that can present with disorientation, hallucinations, or delusions

common misconceptions about mental illness

- feel bad or depressed, must be sick -> false - behavioral health disorder is dangerous, violent, or otherwise unmanageable

behavior

- what you can see of a person's response to the environment -> his or her actions - clear or unclear

behavioral crisis

person exhibits agitation, ivolence, or uncooperative behavior → danger to themselves and others

activities of daily living

• activities a person does in a day → behavioral crisis can interfere

behavioral health emergency

- patients may show agitation or violence or become a threat to themselves others - more serious than behavioral crisis - causes inappropiate behavior - severe impariment in ability to accompanied by bizarre behavior

main concern of behavioral crisis

violence

two categories of physician diagnosis

organic (physical) and functional (psychological)

organic brain syndrome

temporary or permanent dysfunction or brain caused by disturbance in physical or physiologic functioning brain tissue

causes of organic brain syndrome

• sudden illness, traumatic brain injury, seizure disorders, drug and alcohol abuse, overdose, withdrawal, and brain diseases

organic category

organic brain syndrome and AMS

functional disorder

• physiologic disorder that impairs bodily function when body seems to be structurally normal - root cannot be identified

examples of functional disorder

anxiety, schizophrenia, depression

safety guidelines for a behavioral health emergency

- ensure communication - definite plan of action - do not get too close to a potentially volatile patient - express interest in patient's story - avoid fighting

four major contributing areas for SAMPLE history in behavioral crisis

- CNS functioning properly? - drugs or alcohol effects? - significant life changes, symptoms, or illness? - history?

questions to ask in evaluating a mental health disorder

- appropiately answer questions? - withdrawn or detached? hostile or friendly? - normal vocab and expressions? - patient express disordered thoughts, delusions, or hallucinations

signs of CNS dysfunction

rapid movement or blank gaze of eye

if patient is spitting

place surgical mask over mask, wear PPE

best treatment for mental health disorders

be a good listener

psychosis

- state of delusion in which person is out of touch with reality -> in own reality of ideas and feelings - change in behavior - talking to voices in head

causes of psychosis

- mind altering substance - intense stress - delusion - schizophrenia

schizophrenia

- not easily defined or treated - affects how a person thinks, feels, and behaves

schizophrenia onset

early adulthood 16-30 years

symptoms of schizophrenia

- brain damage - delusions - hallucinationso - paranoia - lack of interest in pleasure - erratic speech

how to deal with psychotic patient

- scene safety - identity yourself - be calm, direct, and straightforward - emotional distance and physicians - do not argue - explain everything you are going to do - involve family or friends to gain the person's trust

agitation

behavior characterized by restless and irregular physical activity

treating delirium

- calm, supportive, empathetic - active listener - limit interruptions of patient's comments - emotional and physical distnance - do not leave unintended - assess patient's cognitive functinoing, communications, mood, orientation, memory, concentration, judgement

drug overdose

- take meals and substances - behavioral health facilities - refrain using lights and siren to prevent aggravation

excited delirium aka

exhaustive mania or agitated delirium

signs and symptoms of excited delirium

- irrational behavior with vivid hallucinations -> may see you as a threat - hypertension, hyperthermia, tachycardia, diaphoresis, dilated pupil

uncontrolled or poorly controlled patient agitation and physical violence

cardiopulmonary arrest

positional asphyxia

patient's physical position restricts chest wall movements of causes airway obstruction or sudden death

soft restraints

sheets, wide wristlets, chest harnesses

hard restraints

plastic ties, handcuffs, or leather restraints -> try to avoid

improperly applied restraint

positional asphyxia, aspiration, severe acidosis, sudden cardiac death

legal actions for restraining w/o authority

assault, battery, false imprisonment, violation of civil rights

who to call for behavioral health emergency

law enforcement

emergency doctrine

consent is implied because of necessity for immediate emergency treatment

determining if behavioral health emergency or not

supervisor, protocols, medical control, law enforcement

how many people are preferred for restraints

5 people, one for each extermity and head

level of force for restraint factors

- degree of force to prevent harm - appearance and state - abnormal behavior

other considerations for restraining

- talk to patient throughout whole process - dignity and respect - barrier protection - never leave unintended

restraining physically uncooperative patients

- supine - head @ 30 degree angle - extremities and restrained - trunk needs to be restrained - restrain thights above knees to prevent kicking - surgical mask

when to never transport

hobbled, hog-tied, restrained in prone position with hands and feet behind back

when to remove restraint

never unless emergency and with assistance

what can happen if patient struggling against restraint

severe acidosis or fatal dysrhythmia

2 point restraint technique

one arm is placed toward head and other downward toward waist

risk factors for potentially violent patient

- history - posture -> tense, rigid? - scene -> weapons? - vocals -> loud, aggressive? - physical activity -> tense, glaring, restlessness? - poor impulse control - history of short temper and substance abuse - depression -> 20% of violent attacks - functional disorder

what is the most significant factor for suicide

repression

most common misconception about suicide

suicide patients never act on threat

warning signs of suicide (say like 4-5)

- depression? - avoid eye contacT? - detached from reality? - unable to talk about future? - specific plans related to death? - mentions suicide? - unsafe objects? - environment unsafe? - self destructive behavior? - med or trauma problem? - threat to others? - ultural, religious, social beliefs promoting suicide?

what percent of population has PTSD

7-8%

what percent of veterans of Iraq and Afghanistan have PTSD

20%

what percent of veterans of Gulf War have PTSD

10%

what percent of veterans of Vietnam War have PTSD

30%

signs and symptoms of PTSD

- feelings of helplessness, anxiety, anger, fear - avoid things related to trauma - suffer nervous system arousal and not suppressed

flashbacks

- uncontrollable events triggered by a sound, sight, or smell - last seconds or hours even after long time if happened - perception of danger - hypervigilance, trouble sleeping, irrational behaviors preparing for the worst

dissociative PTSD

- person attempts to escape from constant internal distress or particularly distressing event - ALOC allows person to function under negative conditions - personality disorder, out of body experience, delusions

combat veterans

"- high risk of self harm - use alcohol or drugs as ""anesthesia"" -> addictive - physical pain - high incident of type 2 diabetes, low of brain of brain grey matter - high incidence of TB1 sustained frmo trauma secondary to explosion"

TBI

sensory dysfunction, confusion headaches, memory loss, general disorientation

treating veterans

- low noise - explain everything you are going to do - don't touch without explaining - keep diesel equipment far away - be careful with phrasing questions - ask about service, privacy, ask about suicide

returning veterran clues

- short haircuts - military clothing with combat patches - tattoos - homes related to service - reluctant about opening up for help or PTSD

mental incapacity

unconsciousness, sttress, depression

medicolegal considerations

- determine if mental incapacity - if so determine if involuntary consent with med control - request law enforcement if need to restrain

ovaries

- produce sex hormones and specialized cells for reproduction - absorbed into bloodstream - produce ovum that if fertilized develop and a fetus

fallopian tubes

- connect with uterus and carry egg to uterus - connect ovary to uterus

vagina

- muscular, distensible tube that connects uterus with vulva - manages period - outermost cavity and forms loewr part of birth canal

date rape or club drugs examples

rohypnol or roofies, ketamine, GHB, xanax, ectasy

labia majora and labia minor

folds of tissue that surround urethra and vaginal opening

when is labia damaged

SA

clit

anterior end of labia

anus

posterior end of labia

perineum

area of tissue between vagina and anus

primary reproductive organ

ovaries

uterus

where fetus grows during pregnancy

ovulation

ovum is released

process of fertilization

- sperm goes into reproductive system - sperm passes through cervix into uterus and to fallopian tubes -> one fertilizes as ovum moves down fallopian tube - embryo travels into uterus and attaches to wall and grow -> wall is expecting fertilized ovum

principles for SA

- document everything, only facts - objective SAMPLE - follow policy - any examine genitalia if bleeding - same gender - prevent from bathing, cleaning, eating, etc - transport to facility with experts related to topic

ovum not fertilized

- goes past fallopian tube and into uterus - within 14 days of ovulation -> menstruation - 1 week

pelvic inflammatory disease (PID)

- infection of upper female reproductive organs - disease causing organisms enter vagina during sex and migrate to cervix and uterus

PID affects what parts of the body

uterus, ovaries, and fallopian tubes

what happens if PID expands to fallopian tubes

scarring

PID high risk of

ectopic pregnancy or sterility

what happens if PID affects ovaries

abscess

ectopic pergnancy

pregnancy that develops outside the uterus -> most often in fallopian tube

most common symptom of PID

generalized loewr abdominal pain - aches and worse by walking

signs and symptoms of PID

- abnormal or foul-swelling vaginal discharge - increased pain during sex - fever - malaise - nv - sexually active women

risk factors of PID

- multiple sex partners - untreated STD - history - sexually active - <26 years old - douching - intrauerine for birth control devices

chlamydia

- caused by bacterium chlamydia trachomatis - can lead to PID if untreated

most commonly reported STD

chlamydia

signs and symptoms of chlamydia

- lower abdomen and back pain - nausea - fever - pain during sex - bleeding between preiod

what happens if chlamydia to cervix

rectal pain, discharge or bleeding

rare causes of chlamydia

arthritis, skin lesions, conjunctivities, urinary distention

bacterial vaginosis

- most common vaginal infection in women 15-44 years - normal bacteria in vagina are replaced by other forms of bacteria

signs and symptoms of bacterial vaginosis

- itching, burning, pain, fishy, foul-smelling discharge - pregnant women may have premature babies or babies born with low birth weight

bacterial vaginosis untreated

serious infections or PID

gonorrhea caused by

neisseria gonorrhoeae