Psychiatric Emergencies Part 1

EM Basic

EM Basic LLC

Residency, Student, Medicine, Er, Em, Intern, Health & Fitness, Medical, Education, Emergency

4.6 • 665 Ratings

🗓️ 10 September 2014

⏱️ 38 minutes

🔗️ Recording | iTunes | RSS

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Summary

Today's episode is another installment in the EM Basic Project. Dr. Sheyna Gifford took on the task of interviewing Dr. Les Zun, a nationally known speaker on the topic of psychiatric emergencies. While we did an episode on psychiatric medical screening before, this episode will focus on some of the tougher situations we encounter in the ED. For example- What do we do about the patient who is depressed but not suicidal? How do we calm down agitated patients without reaching for medications? These are tough questions but Dr. Zun goes througha methodical way of thinking about these issues and offers some real world practical advice that you can use on your next shift.

Transcript

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0:00.0	This is Steve Carroll, and you're listening to the E.M. Basic podcast. Today's another installment of the E.M. Basic project. In this episode, Dr. Shana Gifford is interviewing Dr. Les Zune, who is a nationally known speaker in the field of psychiatric emergencies. You may have heard him on a recent episode of MRAP. Today's episode is part one of a two-part series. In this first episode,
0:22.8	they will discuss the basics of evaluating psychiatric patients in the ED. They will also
0:27.6	discuss how to treat agitated patients in the ED and how to properly work up these patients.
0:33.1	Dr. Zun does his own introduction, and he has some conflicts of interest to disclose,
0:39.7	regarding a few of the medications that he talks about.
0:43.4	As always, I myself don't have any conflicts of interest to disclose,
0:47.7	and Dr. Zun's mentioning of certain drugs, for which he does consulting work on,
0:51.0	doesn't imply endorsement by myself or the Ambasid podcast.
0:55.1	I do want to put one concept into context for medical students and interns. Dr. Zun talks a lot about targeted testing in psychiatric patients, especially
1:01.2	those with suicidal ideation who have a normal history and physical exam. He talks about
1:06.7	how it is unnecessary to do shotgun testing in all psychiatric patients and how these tests are
1:11.9	very low yield. I totally agree with him on this point. However, the psychiatric service
1:17.7	you admit your patients to may require these tests before even coming to see the patient,
1:23.2	so you have to work within your own system. If your system requires these tests as a matter of routine,
1:28.7	don't fall on your sword, arguing with your consultant about how they aren't necessary.
1:33.2	In my experience, you will never win these arguments. It's best just to order the tests,
1:37.7	but as a novice learner, know that they are low yield and communicate that to your supervisor
1:42.6	when you present the patient. Finally, my disclaimer,
1:45.8	as always, this podcast is a representative views of opinions that are defense, the U.S. Army,
1:49.1	or the Shostak EM Residency Program. All right, here's psychiatric emergencies part one with
1:53.8	Dr. Shana Gifford and Dr. Les Zune. This is the EM Basic Podcast. This is Shana Gifford.
2:00.5	I'm here at Mount Sinai Hospital in Chicago
	...

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