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Management of the Agitated Emergency Department Patient

Hennepin County Medical Center. Case

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Management of the Agitated Emergency Department Patient

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    1. Management of the Agitated Emergency Department Patient Marc L. Martel, MD Program Director Hennepin County Medical Center Assistant Professor University of Minnesota

    2. Hennepin County Medical Center Case #1 20’s yo male presents by EMS and police to the ED with AMS. Medics report patient was found smashing car windows randomly on a local street. The patient is thrashing about on the EMS gurney, strapped prone to a backboard, handcuffed, screaming profanities, and spitting at providers. What is this clinical entity?

    3. Hennepin County Medical Center Behavioral Emergencies What are they? “I know it when I see it” Justice Potter Stewart, 1964 “…undifferentiated pt presenting with a behavior-related complaint” No true defined criteria

    4. Hennepin County Medical Center Behavioral Emergencies First described 1682, Sydenham Personal experience Negative reactions Appearance Attitude Interactive style Chief complaint Expectation – Reality of encounter Recognize you play a role Escalate Contain

    5. Hennepin County Medical Center Behavioral Emergencies Acute Undifferentiated Agitation Excited Delirium

    6. Hennepin County Medical Center Behavioral Emergencies Acute Undifferentiated Agitation Altered Mental Status Positive symptoms Multiple etiologies Limited EBM

    7. Hennepin County Medical Center Behavioral Emergencies Excited (Agitated) Delirium Acute onset bizarre and violent behavior Combativeness Hyperactivity “Super-human strength” Delusions / hallucinations Hyperthermia DEATH

    8. Hennepin County Medical Center Behavioral Emergencies Etiologies Psychiatric Alcohol Illicit substances Cocaine, PCP, Methamphetamine Intracranial pathology Genetic predilection? Mutated potassium channel

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