Because it gives new readers context. If agitation is the primary difficulty, this combination can be repeated once or twice at 30- to 60- minute intervals until agitation is resolved or until the patient can be appropriately transferred to a higher acuity type facility. Introduction This chapter was reproduced from the Emergency Medicine Clerkship Primer, 2008, Chapter 13, with the permission of the Editor, for ease of viewing on mobile devices. By addressing the disposition early during a patient’s evaluation, you can easily save many hours on the back end, thus reducing a patient’s stay in the emergency department and improving patient satisfaction and patient … The case study on the next page gives an example of planning for disposition early. disposition to an alternative level of care when appropriate. Rule #8 Any patient disposition decision made by a responder will be judged based on the prevailing standard of care – what a reasonable, prudent practitioner with the Change ), You are commenting using your Google account. Always be vigilant for a new, reversible problem that may be worsening a chronic condition. A chronic condition may be managed quite effectively at a lower level of care, especially with supportive family members or community. The front of the page is used to describe the situation and the back lists a variety of specific patient
Panic attacks may be a symptom of several different anxiety disorders.
The case study on the next page gives an example of planning for disposition early.
Next, depending on the availability of a treatment room, the presentation of unexpected emergencies, and staffing resources, a patient may still wait in the waiting room for some time before being brought back to the emergency department for an evaluation. Change ), You are commenting using your Facebook account. Don’t worry about how your blog looks. We will publish relevant case studies in an upcoming issue of JUCM. It is important for the urgent care physician to be aware of the legal processes within the state where he/she practices to allow for the involuntary evaluation and retention of a mentally ill individual. What topics do you think you’ll write about? The Disposition Table – Make it Easy, continued 7 o Frequency: describes the frequency of events o Incidence: describes the number of patients with specific events o Descriptive Statistics calculates N, MIN, MEDIAN, MAX of variables with numeric formats. Some of the nuances of an ICU bed versus a stepdown bed or a stepdown bed versus a telemetry bed may be institution dependent and should always be determined on a case-by-case basis. As the premier organization for high-quality research and educational innovation in emergency care, the Society for Academic Emergency Medicine (SAEM) creates and promotes scientific discovery, advancement of education, and the highest professional and ethical standards for clinicians, educators, and researchers. On the contrary, a good clinician thinks about patient disposition from the moment he or she enters the room. Change ), You are commenting using your Twitter account. In this type of case, the eventual disposition can be made early on in his evaluation.
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In summary, the evaluation of the psychiatric patient in the urgent care setting requires that the clinician assess the symptom complex of the patient and rule out or treat acute contributing medical conditions. Whether this is started from the urgent care setting depends on the timing and availability of follow-up with a primary care or psychiatric provider. The most intense version of anxiety symptoms is a panic attack, which often includes a sense of doom, shortness of breath, chest tightness, diaphoresis, and palpitations. Depressive disorder Just click the “New Post” button, and tell us why you’re here.
Because it will help you focus your own ideas about your blog and what you’d like to do with it. The interventions for patients presenting with psychiatric complaints tend to be pharmacological, psychological, social, and/or medical. Even before you walk into the patient’s room, you should start to think about the differential diagnosis, diagnostic workup, therapeutic management, and of course disposition. At times, a patient may just be frustrated or hungry, concerned about the hospital bill, or perhaps concerned about missing work. Fax: 847.813.5450.
Urgent message: Assessment of patients presenting with psychiatric conditions requires amodified set of skills compared with traditional medical assessment.
Typically, these populations include patients who have been noncompliant with outpatient treatment, have comorbid substance abuse combined with chronic mental illness, and/or comorbid medical illness.
The repeat patient presents a specific challenge in the urgent care setting. In turn, an MI or PE often presents with acute anxiety. Inpatient substance abuse treatment programs would be appropriate if use has been escalating or there is potential for medical instability related to the detoxification process, or unstable vital signs. For example, an elderly patient suffers a hip fracture after a fall. Typically, this would include a combination of 5mg of haloperidol (Haldol), 2mg of lorazepam (Ativan), and 50 mg of diphenhydramine HCl (Benadryl), either PO or IM. Can’t think how to get started? Note that akathisia can present as a side effect of dopamine blocker medications and of phenothiazines often used for gastrointestinal complaints. In a typical ambulatory presentation to the emergency department, a patient undergoes a triage assessment, usually by a nurse, followed by a brief interview by a registrar to obtain medical insurance and other demographic information. A patient such as this should be immediately brought back to the treatment area.
Table 2 offers an overview of options based on the conditions described here.
Examples of the latter include aripiprazole (Abilify), risperidone (Risperdal), olanzapine (Zyprexa), and others. Obtaining the previous psychiatric diagnosis can be useful, especially a review of the interventions which were successful in the past. Just write the first thing that pops into your head. In the urgent care setting, the primary goal is to alleviate symptoms of the actual panic attack and assure appropriate follow-up. For the patient who presents with an acute psychosis— either hallucinations or delusions combined with severe agitation—a combination of medications can be given. Most states require that an individual be both mentally ill and dangerous to either self or others in order to be held for involuntary assessment. Currently, the diagnostic criteria of bipolar disorder have come to be too often loosely applied; some caution should be used in accepting this history in the absence of a careful psychiatric review of systems. At times, the resolution of an acute medical condition will also re- solve the psychiatric symptoms, classic examples being hypothyroidism masquerading as a major depressive disorder, encephalitis presenting with delirium, or a cocaine intoxication mimicking the symptoms of schizophrenia or mania. Outpatient medical treatment of this patient population would include chronic conditions, the management of hormonal imbalances (though perhaps not in the urgent care setting), or follow-up for an acute condition or medication side effect when adequate support is available. Finally, you will have to decide what type of hospital bed a patient will need, that is, a medical–surgical floor bed, telemetry monitoring, stepdown bed, or an intensive care unit (ICU) bed. Mood symptoms are likely to be those of depression or of mania, opposite ends of the spectrum.
Assuming all of these steps are performed in series, you can easily see how a patient presenting with what initially appeared to be a non-urgent complaint can spend many hours in the emergency department. should assist with arrangements for custody of the patient’s body as appropriate (by contacting law enforcement, for example).
In addition, building rapport in a non- confrontational manner and providing the patient an opportunity to express feelings and thoughts as fully as possible may allow him/her to re- solve the condition to the point where a higher level of care might be un- necessary.
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