Psychiatric Complaints

The Two Objectives During Every Psychiatric-Type Complaint
  • Medical Clearance
  • Psychiatric Risk Assessment
Medical Clearance
  • Required by EMTALA to perform a “screening exam” regardless of complaint
  • Most psychiatric facilities have poor diagnostic/treatment capabilities for non-psychiatric conditions and will want patient to be “medically cleared”
    • Sometimes they will require specific tests to be performed, blood pressure to be treated, etc
    • My “medical clearance” order set includes
      • Electrolytes
      • CBC
      • Serum Alcohol
      • Urine Drug Screen (UDS)
      • Pregnancy (if appropriate)
      • Tylenol/Salicylate Levels (especially if suicidal)
  • Psychiatric patients frequently have other non-psychiatric emergencies
    • Overdoses (salicylate, acetaminophen, etc)
    • Trauma (alcoholics with subdural hematoma from falls)
    • Encephalopathy (hypoglycemia, encephalitis)
Psychiatric Risk Assessment
  • Will this patient truly put themself or others at risk if sent home due to mental health?
  • Do you need to involuntarily hold patient?
  • Are they having passive thoughts of being dead or true INTENT and PLAN to harm themself?
  • Did they name a specific person/group of people that they intend to harm?
Additional Reading

1 Comment

  1. Chris Sawyer

    Hey Zack, I just wanted to take a second to thank you. I am a 3rd year DO student who decided on EM at the beginning of this year. A colleague told me about your podcast the beginning of my clerkship and I have absolutely loved and appreciated the succinct and down to earth approach you have to your podcasts. It’s short entertaining and very easy to listen to. I love that you repeat the pertinent information multiple times, this helps with long term potentiation. When I am in the ED your voice pops into my head and because of this I have caught things that have really impressed my attendings.

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