I need some assistance on some Pre-hospital (EMT/EMS) assessment and management on mental illness?
Question:
If you know the answer or know any advice and assistance would be appreciated.
The mental illnesses are:
Bipolar disorder
Multiple Personality Disorder
Schizophrenia
Paranoid Schizophrenia
Depression
Panic Disorder
Phobia
Obsessive-Compulsive Disorder
Post Traumatic Stress Disorder
Anorexia
Bulimia
Answers:
Hello
Im no EMT... Im just a megerly RN. hehehehe.
Although most of my assessments are done in the hospital... I am sure that the most important priority is ABCs! 1) Airway, 2) Breathing, 3) Circulation , followed by SAFETY. then followed by other physiologic needs such as food...
That being said. as an EMT I am sure you can assess whether the patient is stable or is in arrest...
1. If the patient is in arrest... follow BLS protocol or ACLS protocol as needed.
Then you'd want to look at SAFETY. assess the situation quickly... If the patient is trying to cause harm to someone else... if so, get that person to safety. then assess if the patient has a plan of suicide. most mental illness emergencies involve trying to injure oneself or others.
1. MOST IMPORTANT QUESTION: Do you want to hurt yourself? if yes. ask How do you plan to hurt yourself?
Find out of the patient took tooo many of their meds...
most people with mental illness are on many, many different kinds of medications... a common way to try to commit suicide is to try to overdose.
2. your job as the EMT is to find out if, what kind, how many, and how long ago, they took the meds... this will help us in the hospital to see what antedotes if any or what treatments to give them.
3. On a side note... it is more common for females to try to commit suicide... meaning they dont always succeed. and it is more common for males to commit a more lethal form of suicide and follow through... so keeping that in mind... a male may take a larger quantity of substances. or may have use of a weapon. so always remember your safety as well. call Law Enforcement in these cases.
Well I hope this helps you somewhat. Again, I am a nurse and our process of assessment and disease management are from a different perspective than EMTs... so I didnt go into detail. Just a few pointers to remember...
Good Luck,
Angie R.N.
you can google each of these disorders faster than we can copy paste all the information on all of them.
HI as an old EMT I understand your desire for "answers" but am wondering if it's your personal need or something from a "test" which I can't quite imagine.but let me know. There was alot of excellent advice in the previous answer from the nurse. I think you just need to go in reverse order. Cover the ABC's, assesment, etc that doesn't usually change alot. As you know we aren't supposed to diagnose and sometimes feel left out of the loop. My concern, as one that has mentored and instructed many is that some people don't grasp the importance of the basics...and that sometimes we never get further than the abc's. But some get hung up on "what is really wrong" that they ignore the basics(and the patient) to the point of nearly loosing the patient cause they were to busy trying to figure out what was wrong, instead of treating the patient. My suggestion is let you normal assesment inc. history taking, etc lead you where it may. Then, if you have time consider how the mental health issues impact your job. And none of those mental health issues will kill somebody outright...but here we can play detective, get creative with questions, practice our "art"...and in most mental health issues, the call is about anything other than that diagnosis...like what meds did they take, how suicidal have they been, how violent, how threatening ??
I have a few basic rules
1. If pt. acts violent or did in the recent past.gon't push his personal space and never get between the Pt. and a door he can escape from. Never assume a mental case cant turn suddenly violent even if he has been passive...if in doubt...get a cop, etc.
2. Calm reassurance is important in panic anxiety, etc. The breathing the Nurse mentioned is very important and works if you can get the pt to trust and believe you...and help them thru each breath.
3. It is possible to listen a persons soul back into existance...a commpasionate ear that is sincere works better than meds some times.
4. At time we actually can make that call...on when to agree on all matters with a smile...and when to try to insert truths to replace lies they believe.and when to back off in a hurry.
5. Not sure it's important to know all the names or manifestations of the mental health issues...even though they are a passion of mine. But know some of the signs of an impending explosion...like clenching of the jaw..on and off.red faced..if standing, leaning forward and sort of bouncing on the balls of their feet..
6. Hope I'm not boring you.I've gone to extreme lengths to keep pts calm during long transports, but in the end we need to make sure we stay alive to deliver a patient that is alive, doing everything we can within our scoope of practice based on signs, symptoms, assesment, history etc...treating the patient.not the diagnosis.
7. Love to chat more if you like...there is alot to discuss.hope I didn't miss your point altogehter..Feel free to email or use Yahoo IM under..."mysihba"
Hmmm...first off, don't forget the basics.
What's the #1 thing we learned in EMT Basic school? Scene Safety! If there's a chance of a weapon onscene, wait for the police. A dead medic isn't going to do the patient any good.
Size up the scene as you walk in. Don't put the patient between you and the exit. Don't turn your back to a patient who you feel may be a threat. Don't put yourself into a position where you have no escape.
Make patient contact, assess the patient's airway, breathing, and circulation. Be gentle...some patients don't want to be touched. Try to gain their confidence, don't force yourself on them.
Try to assess their signs/symptoms. Get a good history, if you can. The patient's family can be a great source of information, if they are handy.
This is one important rule! Never assume that the only issue is "psych". A few medics have brought a combative patient to the ER only to learn that their blood sugar was in the 40's. Or they assumed that the patient with alcohol on his breath was just drunk. Usually, patients are confused/combative during the postictal stage of their seizures. Many medical problems can masquerade as drunkeness...and I've seen a few "panic" attacks with an underlying asthma exacerbation. Don't let their psych issues lull you into assuming that's the only issue.
One thing I've learned the hard way: Don't argue with schizophrenic patients. Sometimes, they will talk about how their wife is sneaking poison into their coffee, even though it's the sobbing wife who called 911 in the first place. I don't want to aid them in their delusions, but arguing with them just agitates them. Just show a genuine interest in what they are saying...
Panic disorder and phobias are no fun to experience. With a panic disorder exacerbation, it's important to get them to slow their breathing down. My service advocates putting all patients experiencing shortness of breath on high flow 02. At first, I didn't care much for that policy, because I was worried that the high flow oxygen would increase their hyperventilation symptoms, but I've found that the opposite is true. When you give the patient oxygen, he or she feels like you are actually doing something to help them...oftentimes, their breathing will actually slow just because of that. I've gotten a few patients to calm down by having them hold the mask to their face. Concentrating on that task took their mind off the panic attack.
Phobias, by their definition, aren't going to make sense. It won't accomplish a thing (and will actually serve to cause the patient to distrust you) by telling the patient that all she has to do is "get over" her fear. Just be supportive and listen...
For suicidal patients, make sure to ask a few key questions, if they are willing to talk to you: Did you do anything to hurt yourself (take pills, cut yourself, etc)? If they did, be sure to do a good assessment. Also, a medic friend got into loads of trouble when his patient had a self inflicted stab wound to his arm. Turns out the patient also had a stab wound to his abdomen that everyone missed, and the patient didn't tell anyone about the other stab wound! If they took pills, be sure to find out how much, and take the bottle with you, if possible.
Don't forget that you may be able to treat the poisoning with activated charcoal, especially if you are a long ways from the nearest ED. Remember airway! This may become critical if your patient took an OD of narcotics or benzodiazepines.
With anorexia/bulimia, be sure to do an EKG...they may have an underlying cardiac issue from the electrolyte imbalances caused by not eating correctly or purging.
As far as the individual psych disorders you listed, the best thing to do would be to Google them individually and research.
Most paramedic services haven't written protocols for the individual disorders, only a general "psych" protocol.
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