1. Seizures & Psych Emergencies
March 5, 2018

2. Bell Work
1. If a patient has an altered mental status, EMS use the mnemonic AEIOUTIPS to evaluate causes. What does that stand for?
2. In the initial assessment of a scene, how would you classify a patient’s mental capacity?
3. A cerebral thrombosis would be classified as what type of stroke?
4. Decreased blood flow to the brain that is only temporary would be called?
5. What hormone moves glucose from your blood into the cells for energy and storage?
6. What type of insulin would a patient use if they were about to eat? Regular or long-acting?
7. If a patient were hypoglycemic and had a patent IV, what type of fluids could you give them?

3. Altered Mental Status
6. Probable cause of the present condition. What is the underlying pathophysiology causing the patient's altered mental state? One commonly used mnemonic is AEIOUTIPS: Page 601 in book!
Alcohol,
Epilepsy
Insulin
Overdose, opioids or oxygen deprivation;
Uremia
Trauma
Infection, inherited defects;
Psychosis
Stroke, shock

4. Altered Mental Status Assessment
AVPU Assessment when doing initial assessment
(Alert, Voice, Pain, Unresponsive)

5. Objectives
What to do in an emergency if someone has a
Seizure

6. Standard
19) Identify and perform skills to manage life threatening illnesses based on assessment findings of a pediatric, adult, and geriatric patient with medical emergencies identifying anatomical structures involved. Altered mental status Seizures Stroke Gastrointestinal bleeding Anaphylaxis Infectious diseases Diabetes Psychological emergencies Chest pain Poisoning Respiratory distress/Asthma Vaginal bleeding Nosebleeds

7. Seizures
A seizure is a sudden surge or burst of electrical activity in your brain. 
A seizure affects how you appear or act for a short time.
Seizures aren’t always an either-or thing: Some people have seizures that start as one kind, then become another. And it’s not easy to classify some of them: These are called unknown-onset seizures, and they can cause both sensory and physical symptoms.

8. Types of Seizures Partial seizures: Seizure in small part of brain.
cause both physical and emotional effects and make you feel, see, or hear things that aren’t there.
About 60% of people with epilepsy have this type of seizure, which is sometimes called a focal seizure.
Sometimes, the symptoms of a focal seizure can be mistaken for signs of mental illness or another kind of nerve disorder.
Generalized seizures: These happen when nerve cells on both sides of your brain misfire. They can make you have muscle spasms, black out, or fall.

9. Types of Seizures
Tonic-clonic (or grand mal) seizures: These are the most noticeable. When you have this type, your body stiffens, jerks, and shakes, and you lose consciousness. Sometimes you lose control of your bladder or bowels. They usually last 1 to 3 minutes -- if they go on longer, someone should call 911. That can lead to breathing problems or make you bite your tongue or cheek.
Partial Seizure: seizure in a small portion of the brain. Can affect speech or motor function
Absence or Petit- mal Seizures: Blank or absent stare, usually lasting only seconds.
Febrile Seizures: Due to rapid rise in temperature. Common in children between 6 months and 6 years old.

10. Seizure Treatment
Grand mal – do not restrain, but remove objects in way.
Turn patient’s head to right side to allow drainage of saliva
Don’t force anything in the mouth (no oral airway or bit block)
Note the time of onset and when it ends. Most last 3-5 minutes
Note what body parts are involved

11. Status Epilepticus Medical Emergency: Seizure over 5 minutes
Requires airway management to prevent brain damage or death

12. Seizure Video

13. Work it Out
Finish Friday Assignments Questions page 622, 1-12 Vocabulary page 623

14. Bell Work
1. What type of seizure occurs when a patient’s body stiffens, jerks, and shakes, and is a complete misfire of brain activity?
2. What type of seizure is in a small portion of the brain and can affect speech or motor function?
3. What steps do you take when someone has a seizure?
4. When should EMS be called for help with a seizure?

15. Psychiatric Emergency
Patient’s behavior is disturbing to himself, his family, or his community

16. Behavioral Change
Never assume patient has psychiatric illness until all possible physical causes are ruled out

17. Behavioral Change Causes Low blood sugar Hypoxia
Inadequate cerebral blood flow
Head trauma
Drugs, alcohol
Excessive heat, cold

18. Behavioral Change Clues suggesting physical causes Sudden onset
Visual, but not auditory, hallucinations
Memory loss, impairment
Altered pupil size, symmetry, reactivity
Excessive salivation
Incontinence
Unusual breath odors

19. Psychiatric Problems

20. Anxiety Most common psychiatric illness (10% of adults)
Painful uneasiness about impending problems, situations
Characterized by agitation, restlessness
Frequently misdiagnosed as other disorders

21. Anxiety Panic attack Intense fear, tension, restlessness
Patient overwhelmed, cannot concentrate
May also cause anxiety, agitation among family, bystanders

22. Anxiety Dizziness Shortness of breath
Panic attack
Dizziness
Tingling of fingers, area around mouth
Carpal-pedal spasms
Tremors
Shortness of breath
Irregular heartbeat
Palpitations
Diarrhea
Sensation of choking, smothering

23. Phobias Closely related to anxiety
Stimulated by specific things, places, situations
Signs, symptoms resemble panic attack
Most common is agoraphobia (fear of open places)

24. Depression Deep feelings of sadness, worthlessness, discouragement
Factor in 50% of suicides

25. Depression Signs, Symptoms Sad appearance Listless, apathetic behavior
Crying spells
Withdrawal
Pessimism
Loss of appetite
Sleeplessness
Fatigue
Severe restlessness

26. Ask all depressed patients about suicidal thoughts
Depression
Ask all depressed patients about suicidal thoughts
Asking someone about suicide will NOT “put the idea in their head.”

27. Bipolar Disorder Manic-depressive
Swings from one end of mood spectrum to other
Manic phase: Inflated self-image, elation, feelings of being very powerful
Depressed phase: Loss of interest, feelings of worthlessness, suicidal thoughts
Delusions, hallucinations occur in either phase

28. Paranoia Exaggerated, unwarranted mistrust
Often elaborate delusions of persecution
Tend to carry grudges
Cold, aloof, hypersensitive, defensive, argumentative
Cannot accept fault
Excitable, unpredictable

29. Schizophrenia Debilitating distortions of speech, thought
Bizarre hallucinations
Social withdrawal
Lack of emotional expressiveness
NOT the same as multiple personality disorder

30. Violence

31. Suicide
Suicide attempt = Any willful act designed to end one’s own life
10th leading cause of death in U.S.
Second among college students
Women attempt more often
Men succeed more often

32. People who kill themselves, DO talk about it in advance!
Suicide
50% who succeed attempted previously
75% gave clear warning of intent
People who kill themselves, DO talk about it in advance!

33. Take ALL suicidal acts seriously!
Suicide
Take ALL suicidal acts seriously!

34. Suicide Risk factors Men >40 y.o. Single, widowed, or divorced
Drug, alcohol abuse history
Severe depression
Previous attempts, gestures
Highly lethal plans

35. Suicide Risk factors Obtaining means of suicide (gun, pills, etc)
Previous self-destructive behavior
Current diagnosis of serious illness
Recent loss of loved one
Arrest, imprisonment, loss of job

36. Violence to Others
60 to 70% of behavioral emergency patients become assaultive or violent

37. Violence to Others Causes include Real, perceived mismanagement
Psychosis
Alcohol, drugs
Fear
Panic
Head injury

38. Violence to Others Warning signs Nervous pacing Shouting Threatening
Cursing
Throwing objects
Clenched teeth and/or fists

39. Dealing with Behavioral Emergencies

40. Basic Principles We all have limitations
We all have a right to our feelings
We have more coping ability than we think
We all feel some disturbance when injured or involved in an extraordinary event

41. Basic Principles Emotional injury is as real as physical injury
People who have been through a crisis do not just “get better”
Cultural differences have special meaning in behavioral emergencies

42. Techniques Speak calmly, reassuringly, directly
Maintain comfortable distance
Seek patient’s cooperation
Maintain eye contact
No quick movements

43. Techniques Respond honestly Never threaten, challenge, belittle, argue
Always tell the truth
Do NOT “play along” with hallucinations

44. Techniques Involve trusted family, friends Be prepared to spend time
NEVER leave patient alone
Avoid using restraints if possible
Do NOT force patient to make decisions

45. Techniques Encourage patient to perform simple, non- competitive tasks
Disperse crowds that have gathered

46. Behavioral Emergencies
Assessment

47. Scene Size-Up
Pay careful attention to dispatch information for indications of potential violence
Never enter potentially violent situations without police support
If personal safety uncertain, stand by for police

48. Scene Size-Up In suicide cases, be alert for hazards
Automobile running in closed garage
Gas stove pilot lights blown out
Electrical devices in water
Toxins on or around patient

49. Scene Size-Up Quickly locate patient Stay between patient and door
Scan quickly for dangerous articles
If patient has weapon, ask him to put it down
If he won’t, back out and wait for police

50. Scene Size-Up Look for Signs of possible underlying medical problems
Methods, means of committing suicide
Multiple patients

51. Initial Assessment
Identification of life-threatening medical or traumatic problems has priority over behavioral problem.

52. Focused History, Physical Exam
Be polite, respectful
Preserve patient’s dignity
Use open-ended questions
Encourage patient to talk; Show you are listening
Acknowledge patient’s feelings

53. Assessment: Suicidal Patients
Injuries, medical conditions related to attempt are primary concern
Listen carefully
Accept patient’s complaints, feelings
Do NOT show disgust, horror

54. Assessment: Suicidal Patients
Do NOT trust “rapid recoveries”
Do something tangible for the patient
Do NOT try to deny that the attempt occurred
NEVER challenge patient to go ahead, do it

55. Assessment: Violent Patients
Find out if patient has threatened/has history of violence, aggression, combativeness
Assess body language for clues to potential violence
Listen to clues to violence in patient’s speech
Monitor movements, physical activity
Be firm, clear
Be prepared to restrain, but only if necessary

56. Management Your safety comes first
Trauma, medical problems have priority
Calm the patient; NEVER leave him alone
Use restraints as needed to protect yourself, the patient, others
Transport to facility with appropriate resources

57. Restraining Patients
A patient may be restrained if you have good reason to believe he is a danger to:
You
Himself
Other people

58. Restraining Patients Have sufficient manpower
Have a plan; Know who will do what
Use only as much force as needed
When the time comes, act quickly; Take the patient by surprise
At least four rescuers; One for each extremity

59. Restraining Patients
Use humane restraints (soft leather, cloth) on limbs
Secure patient to stretcher with straps at chest, waist, thighs
If patient spits, cover face with surgical mask
Once restraints are applied, NEVER remove them!

60. Reasonable Force
Minimum amount of force needed to keep patient from injuring self, others
Force must NEVER be punitive in nature

61. video

62. Finish Assignments
Diabetes Packet – Scavenger Hunt, Article Review, Advertisement
Book Work – Questions pg. 622, 1-12
Vocabulary – Page 623