Psychiatric Emergencies Part 1

In part one of this two-part EM Basic podcast episode, Dr. Sheyna Gifford interviews Dr. Les Zun, an expert in psychiatric emergencies, about evaluating and managing psychiatric patients in the emergency department. Dr. Zun discusses the importance of distinguishing between medical and psychiatric causes of psychosis, emphasizing targeted testing over routine "shotgun" approaches. He also shares his strategies for managing agitated patients, including verbal de-escalation and medication choices, such as Haldol, lorazepam, olanzapine, and inhaled loxapine, while also exploring the potential future role of ketamine in treating agitation and suicidal ideation. The discussion covers the necessity of thorough physical and mental status exams, including cognitive testing with the clock drawing test, and determining when a psychiatric consult and admission are necessary, while also addressing the assessment of suicide risk and the inappropriateness of using "no-harm" contracts.

Outlines

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EM Basic

Introduction to Psychiatric Emergencies in the ED

Initial Evaluation and Testing for New-Onset Psychosis

Managing Physical Exams and Agitation in Psychiatric Patients

Pharmacological Management of Agitation and Potential of Ketamine

Identifying Medical Mimics of Psychosis and Mental Status Examination

Determining the Need for Psychiatric Consultation and Admission

Approach to the Depressed Patient and Suicide Risk Assessment

Against the Use of "No-Harm" Contracts and Conclusion of Part 1

Psychiatric Emergencies Part 1

EM Basic

00:00Introduction to Psychiatric Emergencies in the ED

Introduction to Psychiatric Emergencies in the ED

04:14Initial Evaluation and Testing for New-Onset Psychosis

Initial Evaluation and Testing for New-Onset Psychosis

10:51Managing Physical Exams and Agitation in Psychiatric Patients

Managing Physical Exams and Agitation in Psychiatric Patients

15:06Pharmacological Management of Agitation and Potential of Ketamine

Pharmacological Management of Agitation and Potential of Ketamine

21:07Identifying Medical Mimics of Psychosis and Mental Status Examination

Identifying Medical Mimics of Psychosis and Mental Status Examination

27:01Determining the Need for Psychiatric Consultation and Admission

Determining the Need for Psychiatric Consultation and Admission

30:46Approach to the Depressed Patient and Suicide Risk Assessment

Approach to the Depressed Patient and Suicide Risk Assessment

36:31Against the Use of "No-Harm" Contracts and Conclusion of Part 1

Against the Use of "No-Harm" Contracts and Conclusion of Part 1