Chapter 26 - Behavioral Emergencies

You are assessing a patient with schizophrenia. Friends called 911 because he was experiencing hallucinations this morning. He is prescribed Thorazine and Resperidone for his illness. Which one of the following questions is most pertinent to the current situation and must be asked first?

"Have you been taking your medications as prescribed?"

You have arrived on the scene where a depressed patient is crying in an upstairs bedroom. When assessing her, which one of the following must be done first?

Check a radial pulse.

You have been called to an assisted living facility for a 43-year-old male who has a history of anxiety and schizophrenia and who, according to staff, is more confused today. The staff also states that he has refused to take his medications for the past three days. Your assessment reveals him to have no life threats to the ABCs, but is slurring his speech and not making sense when he talks. As you review paperwork provided to you by staff, you note that he has a history of thyroid problems, diabetes, and hypertension. His pulse is 124, respirations 16, and blood pressure 154/70 mmHg. At this point, which one of the following actions is most important?

Check his blood glucose level.

An alert and oriented 18-year-old female has threatened to hurt herself, but is refusing transport to the hospital. She is calm and states that she knows her rights and taking her would constitute false imprisonment. Her family is present and wants her to go to the hospital for help. Given the situation and the patient's threat, what is your best course of action?

Contact law enforcement for assistance.

A woman has called you for her middle-aged friend who has stopped eating and talking and has frequent crying spells. Your history reveals that the woman lost her husband a few months ago and has been withdrawn and despondent ever since. Throughout the assessment, the alert and oriented woman continually states she wants to be left alone. When you bring the stretcher into the room, the woman states, "I do not want to go to the hospital. Let me sign whatever I need to sign." What is your best response to this situation?

Contact medical direction and ask for advisement.

When on the scene of a patient who has attempted suicide, what is your priority?

Crew safety

You are by the side of a young male patient with a history of behavioral problems. Friends called 911 after the patient experienced several violent outbursts this evening. Which one of the following findings would cause the EMT to suspect a physical cause for this behavior, as opposed to a behavioral one?

Dilated pupils that are sluggish to react

What is your first priority in managing a patient with a behavioral emergency?

Ensuring the safety of you and your partner

An EMT is transporting a restrained patient who is trying to spit on him. Which one of the following would the EMT be justified in doing?

Placing a surgical mask over the patient's mouth

You are on a scene with a patient who up until a few seconds ago was calm and compliant. Now he is brandishing a knife and threatening to kill you and your partner if you do not immediately leave. The man is intoxicated and police have been notified but have not yet arrived. Which one of the following is your best course of action?

Remove yourself, your partner, and family from the house.

You have been dispatched to transfer a patient with schizophrenia from a hospital emergency department to a psych department at another hospital. While en route, your partner states that he cannot remember what schizophrenia is. You should tell him that schizophrenia is a behavioral disorder commonly characterized by:

delusions and hallucinations

You are assessing and treating a young girl who superficially cut her wrists in a suicide attempt. Bleeding was not significant and has clotted. While transporting the patient, which one of the following statements is most appropriate?

"I am going to clean these cuts with some water and then wrap them."

While transporting a patient with schizophrenia, he suddenly screams, "Do you see that snake? It is right next to you! Kill it!" How should you respond to this patient?

"I do not see a snake; I see a stethoscope. I do not doubt that you see a snake."

You are loading a 24-year-old male for transport to the hospital after he stated that he wanted to kill himself. The patient's father pulls you aside and tells you that his son repeatedly has been in the hospital for suicidal statements but is then released and comes home and the whole cycle repeats itself. He is worried that one day his son will actually commit suicide and wonders if there is anything he can do to decrease the chance of this happening. In regards to the most common means by which people commit suicide, you should respond by saying:

"I would suggest gathering up all guns and removing them from the house."

You are preparing to transport a patient with a behavioral emergency to the hospital. As he is being loaded into the ambulance, he smiles and says, "What if I decide to just go crazy and hurt you during the ride to the hospital?" Which one of the following is your best response?

"If you touch or hurt me, you will be physically restrained immediately. No question."

Which one of the following statements shows that the EMT has a good understanding of dealing with a behavioral emergency patient?

"It is okay to spend an extended amount of time on scene before transporting patients with behavioral problems."

A 48-year-old female with a history of depression has called for help because she feels suicidal. During transport, the patient refuses to talk to you despite repeated attempts for her past medical history and the events leading up to her call for help. Which one of the following statements is most appropriate at this time?

"It's okay if you do not want to talk, I will be right here if you change your mind."

Which one of the following statements made by an EMT shows a proper understanding of what is required when restraining a patient?

"One person should be assigned the task of explaining everything to the patient before, during, and after he has been restrained."

After taking a patient to the hospital for an unsuccessful suicide attempt, your partner states that this is the fifth suicide call he has had this month. Four of them have been women who were unsuccessful and the fifth was a man who shot himself in the head and was dead on the scene. Which one of the following responses is most accurate?

"That seems to make sense, given that more women than men attempt suicide but men are generally more successful."

After taking a young, depressed female to the hospital your partner says, "I am tired of running all of these psych patient calls. There are real patients with real emergencies and pain out there. It is just a waste of our time!" Which one of the following is your best response?

"Those with behavioral emergencies are suffering from emotional pain and injuries, which can be just as real as physical pain."

A group of EMTs is preparing to restrain a large and violent patient. Which one of the following instructions given by the team leader is most appropriate?

"You distract him by coming at him from the front and the rest of us will come at him from different directions, each taking a separate limb."

Which one of the following patient descriptions would the EMT classify as a behavioral emergency?

36-year-old male with no known history who is hearing voices

Given the research related to suicide, which one of the following patients should the EMT recognize as the highest risk for a suicidal action?

72-year-old widow who was just informed of a diagnosis of Alzheimer's disease

You arrive on scene to find that the police have subdued a violent man with a history of behavioral problems. They state they will put the patient on the stretcher. Which one of the following should cause the EMT to take immediate and corrective action?

Patient is placed and restrained in a prone position on the stretcher.

Which one of the following patients is the EMT justified in restraining?

Patient threatening to kill his wife and trying to leave the scene

You are transporting a restrained 23-year-old female with a past history of sexual abuse and multiple behavioral problems. She is very upset with being restrained as well as going to the hospital. She informs you that she will take you to court for your actions. Consequently, you are concerned about false accusations. Which one of the following is your best protection?

Thoroughly document everything that happens on the call.

You are on the scene of a male patient who threatened to take pills to end his life. In talking with the patient, he informs you that he just got a new job that requires more of his time and his wife has been giving him a hard time about it. Tonight, he had enough and just made the comment because he was mad at her. He says that although he is still upset, he doesn't plan to do anything drastic. Before taking further action, which one of the following facts about the patient should raise the EMT's suspicion that he is indeed at a higher risk for suicide?

Unsuccessful attempt three years ago

A patient states that she cannot leave the house to go to the hospital "because I am scared I will do something idiotic and lose it and then everyone will look at me and laugh." She states she rarely leaves the house and the last time she did, she began to hyperventilate. This caused her to return home immediately. Based on this information, the EMT should recognize the patient as suffering from:

agoraphobia

You have been called to a residence for a complaint of chest pain. On scene you are met by the patient's husband who informs you that his wife suffers from anxiety attacks and that she received bad news tonight concerning her mother. This increased her anxiety, and now she just needs to calm down. He states that her doctor said the chest pain she gets is just a temporary response to the anxiety. Assessment of the 46-year-old woman reveals her to be extremely anxious and complaining of chest pain. In treating this patient, the EMT should first:

apply oxygen.

You have been dispatched to transfer a patient with schizophrenia from a hospital emergency department to a psych department at another hospital. While en route, your partner states that he cannot remember what schizophrenia is. You should tell him that schizophrenia is a behavioral disorder commonly characterized by

delusions and hallucinations.

You have been called to the post office to assist police with a disorderly male. On scene you find a middle-aged male patient stating that he needs to be protected because the CIA is out to get him for something he did not do. As a knowledgeable EMT, you should recognize the patient's behavior as:

paranoia.

You have been called to a nursing home for a 48-year-old male with a history of schizophrenia. On scene you find the patient to be highly agitated and clutching his left hand while complaining that there are bugs in it. After performing the primary assessment and finding no life threats, you should:

physically and thoroughly assess his left hand.

You are responding to a home for injuries resulting from a domestic altercation. In preparation for patient contact, what would you tell your partner?

"Do not let the patient get between you and the door."

You have been called for a young male patient who has been withdrawn. The patient appears depressed and when you ask him if he is thinking about hurting himself, he answers "yes." The next question asked by the EMT should be:

"Do you have a plan?"

You have been called to an assisted living facility for a 43-year-old male who has a history of anxiety and schizophrenia and who, according to staff, is more confused today. The staff also states that he has refused to take his medications for the past three days. Your assessment reveals him to have no life threats to the ABCs, but is slurring his speech and not making sense when he talks. As you review paperwork provided to you by staff, you note that he has a history of thyroid problems, diabetes, and hypertension. His pulse is 124, respirations 16, and blood pressure 154/70 mmHg. At this point, which one of the following actions is most important?

Check his blood glucose level

After restraining a patient on the stretcher, what action is it essential that the EMT perform first?

Check the tightness of the chest strap

How can the EMT best keep a behavioral patient calm and avoid provoking a violent outburst?

Inform the patient of all that is going on and use a calm voice throughout care.

According to family, a 24-year-old female suddenly began to act in a hostile manner. After assessing her, you determine that she cannot remember her name or present location and is drooling. Based on these findings, you should suspect a:

behavioral emergency resulting from a physical condition

Bystanders called 911 for a female patient who was screaming obscenities in a store parking lot. On arrival you find the patient to be sitting in the middle of the parking lot muttering incomprehensible phrases. After conducting the primary assessment and finding no immediate life-threatening conditions, you move her to the ambulance. Additional assessment findings include abrasions to her arm and urinary and fecal incontinence. She also has a bottle of Prozac in her pocket. You reference Prozac in your medication book and find it to be used to treat depression. With this information, how will you treat this patient?

Administer high-flow oxygen and transport on her left side.

Your partner is assessing a patient who has a history of antisocial disorder and who just got into a heated verbal exchange with his neighbor. He threatened to kill his neighbor and 911 was called. As you observe the patient, which one of the following is the strongest indication that the patient may be ready to have a violent outburst?

Clenching of both fists

During transport, a female patient who is restrained begins to cry and states that she is sorry for becoming violent and will not behave in that manner anymore. She requests that the restraints be removed because they are hurting her arms and legs. Which one of the following would be appropriate?

Free one arm from the restraint, but leave the rest in place.

You are responding to a patient with a behavioral problem. While en route, dispatch contacts you and states that there is a mental-health delegate at the scene and you will be transporting the patient to the local psych hospital for treatment of her bipolar disorder. On scene which one of the following patient behaviors should help confirm that the patient is suffering from bipolar disorder?

Happy, excessively cheerful, and elated behavior

You have had to restrain a patient who is being involuntarily committed to a psychiatric institution. During the restraint process, the patient vomited. How should you position him on the stretcher?

Left lateral recumbent