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Behavioral Emergencies
Leslie S. Zun, MD, MBA, is chairman of Emergency Medicine at Chicago's Mount Sinai Hospital. He is an expert in violence prevention and behavioral emergencies … and has published widely in these areas and in mental status evaluation, treatment, and the medical clearance process of psychiatric patients in the emergency department. In this lecture, he explains correct approaches to evaluation, basic psychiatric diagnoses, and appropriate treatment. Dr. Zun describes the medical clearance process of psychiatric patients in the emergency department or office setting as presenting several problems for physicians because of its lack of precision and standardization. He calls for improved documentation of the process while noting its purpose, the reasons for performing it, and emergency physicians' role in it. The author discusses the several components for evaluation of the medical clearance process, noting that a reliable history is the most significant. There is little agreement on testing, he says, citing several types of testing for psychiatric patients in the ED, but pointing out that several others advocate little or no testing because not all psychiatric patients are the same; even so, protocols for psychiatric admissions are in the process of being developed. Returning to the issue of poor documentation, Dr Zun notes that some terms such as "medically clear" have the capacity to confuse rather than enlighten. He describes the categories of psychiatric diagnoses, including thought, mood, anxiety, cognitive, and personality disorders … and goes on to discuss the indications for prescribing psychoactive medications in the office or ED. Such medications include antidepressants, mood stabilizers, and antipsychotics. In a section on agitation in theoffice or ED setting, he illustrates the causes and the various medications and restraints that are used for controlling agitation and reducing the likelihood of violence. |
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