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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
