Behavioral EmergenciesChapter 33

Guillermo De La Renta

OK so…

Behavior….

• An individuals action or reaction in response to external or internal stimuli• Can be normal or

abnormal (subjective)

Behavioral emergency….

• A form of altered mental status• Behavior abnormal

within the context of the situation• Variety of causes

Neurosis vs Psychosis…

Neurosis

• Person exhibits abnormal behavior, but remains able to understand the normal boundaries of reality

Ex. • Anxiety• Depression• Paranoia• agitation

Psychosis • Person exhibits

abnormal behavior, and has altered perceptions of reality• Ex.• Schizophrenia• Bipolar disorder

Causes of behavioral emergencies

• Medical disorders• AMS possible NOI• Underlying issue often hypoxia, hypoglycemia• Ex. Epilepsy, hypotension, diabetes…

• Chemical exposures• Alcohol, drugs• Frequent cause of BE• Prescription or recreational (ex. Insulin vs. alcohol)

• Trauma• Brain injuries cause AMS and behavioral disorders

• TBI wide range of symptoms• Blood loss hypoxia in brain• Hypo and hyperthermia brain is pissed

• Behavioral conditions• Your psyche is complex • I.e. psychiatric s%&*

Signs and symptoms• Agitation• Paranoia• Stress-laden speech• Bizarre actions or

thoughts• Self-destructive behavior• Mental confusion• Hostility• Uncontrolled (scream)

crying

Assessment and Treatment

Assessment

• Scene safety BEs can escalate • (0 100, real quickly)

• Consider possible contexts• Try to notice subtle

behaviors• Don’t forget about basic

documentation and assessment (SAMPLE, oprst, vitals…)

Management

• Preventative • Keep patient and rescuers

safe• Supportive • Correct potential threats to

life• Assume behavior is from

medical condition treat accordingly

Restraint

Indications

• When patient is endangering self or others

How-to!

• Best done by LEO

• Reasonable force

• Ideally, minimum 5 people