So another thing we wanna make sure we’re focusing on
in the Emergency Department is that we’re approaching these patients
in an empathetic patient centered way.
We wanna rule out and treat medical illness if it’s present.
Ultimately, we wanna be sure that if our patient is deemed necessary
to go to a psychiatric hospital for admission,
that they’re safe to go there,
that they don’t have any acute medical illness
that would prevent that.
Most psychiatric hospitals are not able to care
for patients with acute medical illness.
Our other goals are to maintain safety
and what this means is we want our patients to be
on suicide precautions generally.
We want them to have a sitter or be in a safe space.
It’s important also to search patients for weapons
or items that can be used for self-harm.
Some of these things might seem relatively harmless like a necktie
but it’s important that we take that away from patients
who are thinking of hurting themselves
and we keep that stuff safe for them until they’re deemed safe for discharge
or for admission to a psychiatric facility.
Now, we also wanna make sure
that we’re keeping our staff as well as the patient safe.
Patient safety and staff safety, physical and seclusion may be necessary.
So patients may need to be placed in a room by themselves
while they calm down, especially for an agitated patient.
Patients may also need some form of chemical sedation.
Chemical sedation can be Benzodiazepines,
a short acting anti-psychotic such as haloperidol
may benefit the patient as well.
The key things are is that you wanna make sure
that your staff, yourself, and the patient won’t get harmed
by agitated or aggressive behavior.
Now, you wanna talk with your patient
and perform ultimately your risk assessment when the patient is sober.
You wanna make sure you’re involving mental health providers
and that will vary institutionally who will be in your Emergency Department
to help evaluate these patients.
You wanna try and determine disposition.
What is gonna be the best place for the patient to go
after discharge or where is gonna be the best place for the patient to go
if they need to be admitted?
And you wanna make sure when you’re doing this
that you’re focusing on those risk factors.
So thinking about risk factors, access to firearms,
any kind of substance abuse history,
any kind of prior attempts, and a history of psychiatric illness.