BEHAVIORAL EMERGENCIES

1. BEHAVIORAL EMERGENCIES DAN MUSE, MD

2. BEHAVIORAL EMERGENCIESDEFINITION • Walter Payton`s father, Edward, died at 54 in 1979 under circumstances that are not clear. Arrested by a young, white policeman for driving while intoxicated, he was put in Columbia`s jail to ``dry out`` and was found dead a few hours later.

3. BEHAVIORAL EMERGENCIESDEFINITION • The coroner found no traces of alcohol or drugs and said he died of a cerebral hemorrhage. A court-ordered autopsy cleared local officials of wrongdoing.

4. BEHAVIORAL EMERGENCIESDEFINITION BEHAVIORAL EMERGENCY: a temporary change in behavior or exacerbation of a chronic underlying behavioral disorder that results in a threat to the patient or others.

5. BEHAVIORAL EMERGENCIES BEHAVIORAL EMERGENCIES are a specific subset of altered mental status.

6. AMS ALTERED MENTAL STATUS IS A SYMPTOM AND NOT THE DIAGNOSIS CAUSES • INFECTION: Meningitis, Sepsis • STRUCTURAL: Stroke, Trauma, Seizure • METABOLIC: Hypoglycemia, Hyponatremia • INGESTIONS: Narcotics, Alcohol, PCP…… • PSYCHIATRIC: Psychosis, Bipolar….... • CONGENITAL/GENETIC

7. AMSPNEUMONIC • A – Alcohol • E – Epilepsy • I -Insulin • O – Opioids /Drugs • U- Uremia • T– Trauma, Temperature • I– Infection • P– Poisonings • P– Psychiatric • S– Stroke, Shock

8. ALCOHOL

9. BEHAVIORAL EMERGENCIESALCOHOL • Results in behavioral changes by itself • In the inebriated state we oftentimes see personality changes….

10. NOT ALL DRUNKS ARE THE SAME

11. QUIET DRUNK

12. MATH CLUB DRUNK

13. MAKE YOUR MOTHER PROUD DRUNK

14. GUY FANTASY DRUNK

15. THE ASSHOLE DRUNK

16. BEHAVIORAL EMERGENCIESALCOHOL • The drunk asshole • We all know him and some of us have been him. • There is usually a sense of importance. • They are argumentative and believe they are always right • They can become destructive and violent.

17. BEHAVIORAL EMERGENCIESALCOHOL EXCEPT FOR THE VIOLENT BEHAVIOR, THEY ACT LIKE…….

18. A FIRE CHIEF!!!!!

19. https://www.youtube.com/watch?v=C0Wu7SQ6jiw

20. BEHAVIORAL EMERGENCIESALCOHOL • The drunk asshole is a temporary but oftentimes a recurring condition.

21. BEHAVIORAL EMERGENCIESALCOHOL • Drops in alcohol may result in seizures and delirium in chronic alcoholics • Either a seizure and a post-ictal state or delirium can result in behavioral changes which may cause the patient to be a threat to himself.

22. SEIZURES

23. BEHAVIORAL EMERGENCIESEPILEPSY (SEIZURE) • INTRINSIC SEIZURES • STRUCTURAL: Space occupying; tumor, bleed, edema. • HYPOXIA. • POISONINGS: INH • METABOLIC: Hypoglycemia, Hyponatremia • INFECTION: Meningitis; Febrile Seizures • PSYCHIATRIC: Pseudo-seizures

24. TYPES OF SEIZURESEPILEPSY FOUNDATION • Absence Seizures • Atypical Absence Seizures • Atonic Seizures • Clonic Seizures • Myoclonic Seizures • Tonic Seizures • Tonic-Clonic Seizures • Simple Partial Seizures • Complex Partial Seizures • Secondarily Generalized Seizures • Febrile Seizures • Nonepileptic Seizures • Refractory Seizures • New Terms and Concepts for Seizures and Epilepsy • Gelastic and Dacrystic Seizures

25. ABSENCE SEIZURE • Absence seizures are lapses of awareness, sometimes with staring. • They begin and end abruptly, lasting only a few seconds. • More common in children. • Absence seizures can be so brief that they sometimes are not detected for months.

26. ABSENCE SEIZURE • Simple absence seizures: During a simple absence seizure, a person usually just stares into space for less than 10 seconds. Because they happen so quickly, it’s very easy not to notice simple absence seizures — or to confuse them with daydreaming or not paying attention.

27. ABSENCE SEIZURE • Complex absence seizures: During a complex absence seizure, a person will make some kind of movement in addition to staring into space. Movements may include blinking, chewing, or hand gestures. A complex absence seizure can last up to 20 seconds.

28. https://www.youtube.com/watch?v=eH-eEE52F6Y

29. SIMPLE PARTIAL SEIZURES • Simple partial seizures can be motor seizures that cause change in muscle activity. • These seizures can be sensory seizures that cause changes in any one of the senses. • These seizures can be autonomic seizures that cause changes in the part of the nervous system that automatically controls bodily functions. • These seizures can be psychic seizures that change how people think, feel, or experience things.

30. https://www.youtube.com/watch?v=veInfvb-cEs

31. COMPLEX PARTIAL SEIZURE • Complex partial seizures last 1 to 2 minutes. • These seizures may have an aura (or warning).  • Complex Partial Seizures include automatisms (such as lip smacking, picking at clothes, fumbling), unaware of surroundings or may wander.

32. https://www.youtube.com/watch?v=hyj7MSdaLqw

33. DIABETES

34. AMSDIABETES • Hypoglycemia • Results in cognitive impairment. • Behavior can be dull, somnolent, and confused. • It can also result in confusion and agitation.

35. AMSDIABETES • Checking for a low blood sugar is always part of the AMS evaluation

36. DRUGS

37. DRUGS • Drug abusers oftentimes have underlying psychologic issues. • The combination can result in behavioral changes that can result in potential harm to themselves and/or others.

38. DRUGSNARCOTICS • Use of narcotics result in a sedative state. • Withdrawals or use of naloxone result in agitation • This in turn can cause aggressive behavior.

39. COCAINE • A stimulant • Causes elevated heart rate and blood pressure • Can become agitated • May develop psychosis • Can result in vascular events; head bleed, heart attack

40. COCAINE • CNS effect depends on amount used and to some extent the personality of the person • Manic behavior and euphoria may occur • Psychosis with delusions, paranoia and hallucinations are possible.

41. DISSOCIATIVE AGENTS • Drugs such as PCP (phencyclidine) and ketamine, were initially developed as general anesthetics for surgery • Distort perceptions of sight and sound and produce feelings of detachment (dissociation) from the environment and self.

42. DISSOCIATIVE AGENTS • These mind-altering effects are not hallucinations. • Pcp and ketamine are therefore more properly known as "dissociative anesthetics."

43. DEXTROMETHORPHAN • Dextromethorphan, a widely available cough suppressant, when taken in high doses can produce effects similar to those of pcp and ketamine.

44. PCPPHENCYCLIDINE • PCP is a synthetic hallucinogen. • Used for recreational purposes • Has the ability to cause the user to feel invulnerable and exceptionally strong • Is sometimes mixed in marijuana

45. PCPPHENCYCLIDINE • The drug also cause analgesia and extremity numbness. • Combined with the hallucinations and sense of superhuman strength, these patients are cause for major trauma to themselves and those trying to restrain them.

46. PCPPHENCYCLIDINE

47. HALLUCINOGENS • Hallucinogens are natural and synthetic drugs that create a distortion of ones senses. • A person may see, hear feel things that are not real. • How they react to these hallucinations dictates what they may do to themselves and others

48. HALLUCINOGENS • Lysergic acid diethylamide (LSD) and psilocybin mushrooms are two examples of synthetic and natural hallucinogens. • Indian tribes use the mushrooms for religious practices.

49. PREVALENCE OF STUDENTS WHO HAVE USED HALLUCINOGENS AND PCP Source: Monitoring the Future Survey, 2000 Note: Data not available for PCP Prevalence for 8th and 10th graders

50. METHAMPHETAMINE • Synthetic drug that is easily made on the streets. • Highly addictive and leads to long term health and psychiatric issues.