There is different methods of attempting suicide
and possibly completing suicide.
So one is firearms.
Firearms are the most common method of completed suicide
and this is more common among males.
So this plays into that statistic that men are more likely to complete suicide.
Poisonings, more common among females,
and prescription drugs, more common than illicit substances.
You know, a lot of poisonings actually are not fatal.
So patients take medications and some of them can do a lot of harm.
But more often than not, the medications
will be processed by the body and patients will do okay.
They may need some supportive care,
some supportive treatment depending on the medication.
That’s not to undermine them.
Patients can definitely harm themselves with these medicines.
but the reasoning that women are often times less successful
in completing suicide is for this reason.
So this is one of the big reasons here.
Hanging or suffocation and then self-inflicted trauma.
So those are the four main or big ways.
There’s definitely other ways that people can think of to harm themselves.
but these are the four big things that we see.
One of the big considerations in the Emergency Department is screening for suicidality.
And there’s different ways to think about screening patients in the Emergency Department.
Different facilities will feel differently and will do different levels of screening.
The first is universal screening.
So what that means is that all patients are asked about suicidal thoughts.
So every patient who comes through the Emergency Department
with any chief complaint, their belly might hurt,
they may have a headache, they may have chest pain.
They’re going to ask if they’re having any suicidal thoughts.
You know the thinking behind this is that it can pick up on some occult suicidality.
So patients who wouldn't necessarily admit it, or tell someone,
those are the patients who would be picked up by this universal screening.
There’s also selective screening.
Selective screening is for patients who are in high-risk groups.
We talked about the high-risk groups,
elderly white males, people who abuse substances,
that's the high-risk group patients.
And then those patients will be the only ones that were asked about suicidality.
Then there’s indicated screening.
Indicated screening is for patients who have red flag symptoms.
So they’ve told you something concerning
or they've done something concerning,
and those will be the only patients screened.
You know, like I said, this varies based on institution
and based on patient population
what screening the facility would adapt.
So a key point in the history of a patient who admits to suicidality
or who there is concerned about that is obtaining collateral information.
And that basically means is it means
that you’re going to talk with someone that knows the patient.
Either a friend or a family member, or the patient’s therapist or psychiatrist.
Someone who's able to give you additional information.
Because we know that patients might not always necessarily be forth coming
in their symptoms or what they’re telling you.
The other thing you wanna remember is to be on the lookout for non-accidental trauma.
Sometimes although it’s not super common or very common,
Patients will get in a car accident that was intentional, in an effort to hurt themselves
or they'll do something that might not necessarily be obvious to the physician,
so it’s different then when someone comes in with an obvious self-inflicted trauma.
But for patients in whom stories don’t feel right,
or you’re not exactly sure what happened,
or they're not able to recount the story to you,
or anything else that’s a red flag,
go ahead and start asking the questions.
It doesn't hurt to ask people the questions.