Psychiatric Medical Screening
EM Basic
EM Basic LLC
4.6 • 665 Ratings
🗓️ 22 October 2012
⏱️ 29 minutes
🧾️ Download transcript
Summary
In this episode, we will discuss how to perform medical screening for patients with psychiatric complaints. While most of these workups are routine, we have to be able to catch the small percentage of patients who have a medical cause to their psychiatric complaint. Don't think it can't happen to you- it almost happened to me twice during residency! We'll discuss how to stay safe while evaluating psychiatric patients, how to get the entire history, how to do appropriate testing, catch the red flags, and make the appropriate disposition.
In the bonus section, a community ED doctor wrote me to tell me his thoughts on testicular pain and why we may not need an ultrasound on every patient. As you'll hear, the answer is far from settled and not without controversy.
Transcript
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| 0:00.0 | This is Steve Carroll, and you're listening to the EM Basic Podcast. |
| 0:04.6 | Today we'll be talking about psychiatric medical screening. |
| 0:07.6 | This is a process where we evaluate patients with a primary psychiatric complaint |
| 0:12.0 | for any medical issues that could be causing or contributing to their psychiatric condition. |
| 0:18.1 | While these charts are not usually the most coveted charts in the rack, there are a lot |
| 0:22.1 | of pitfalls to evaluating these patients. Every once in a while, we can make a great catch that we'll |
| 0:28.3 | find that rare medical condition that will save the patient from harm and from a psychiatric admission. |
| 0:34.2 | We'll talk about how to approach the workup to these patients, how to appropriately |
| 0:38.4 | screen them for medical issues, and how to catch those patients who have a medical cause |
| 0:43.3 | to their psychiatric condition. As always, this podcast doesn't represent the Voozy |
| 0:47.2 | Opinions of the Department of Defense, the U.S. Army, or the Ford Hood Post Command. |
| 0:51.2 | So let's get started. Before we even look at the chart, let me hammer home one |
| 0:55.9 | very important point when it comes to screening psychiatric patients. Your utmost concern at all times |
| 1:02.6 | has to be the safety of yourself, your staff, and the patient. If you have ever trained as an |
| 1:08.8 | emergency medical technician or other first responder, you'll |
| 1:12.5 | know that the very first thing you do is to make sure that the scene is safe. |
| 1:16.9 | In fact, I am sure that hearing that term brings back memories of practical exams where |
| 1:22.0 | the first words out of your mouth were, scene safe, body substance isolation precautions. |
| 1:32.7 | In this case, scene safety means ensuring that the patient does not have the means to harm anyone else and that they are changed into a gown with their clothes and shoes stored somewhere |
| 1:38.0 | outside of their room. These patients need to be stripped down to their underwear to ensure |
| 1:43.1 | that they don't have any weapons on their person. If necessary, involve your security staff and or the police to do this. |
| 1:51.0 | Having the patient take off their clothes and shoes and removing them from the room will make |
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