9 articles Psychiatry

Panic Attack

Panic Attack: Sx: Hyperventilation leading to peri-oral numbness and/or bilateral hand numbness, dizziness/lightheadedness, sense of dread/doom, tachypnea, tachycardia, elevated BP, palpitations, SOB, chest pressure. Order: EKG, CBC, CMP, TSH, Troponin, Chest x-ray, UA. If chest pressure is present: EKG, Troponin, Aspirin 325mg PO X 1 dose, NG, +/- Morphine if chest pain does not resolve.…

Depression

Depression: Tx: SSRI (Fluoxetine – Prozac), Sertraline Venlafaxine (Effexor) 37.5mg PO qd (SNRI) Trazodone (SRI) is primarily used for the treatment of depression. It is sometimes prescribed as a sedative (insomnia), and also is used in combination with other drugs for the treatment of panic attacks, aggressive behavior, agoraphobia, and cocaine withdrawal. Refer to psych…

Opioid Withdrawal

Opioid Withdrawal: Sx: restless, anxious, agitated, diarrhea and/or abdominal cramping, dilated pupils Increase RR, increase BP Admit to a telemetry Bedrest: Complete Vital signs q4hrs. Toxicology: Plasma alcohol level, UDP (urine drug panel), Opiates conformation/quantitation (blood), UA, CBC, CMP. Initiate opiate withdrawal protocol. Do not give patient any narcotics.  Haldol PRN was also added for…

Alcohol abuse/withdrawal

Alcohol abuse/withdrawal: Begin Delirium Tremens protocol (CIWA) Place patient on the CIWA protocol for alcohol withdrawal and monitor closely for symptoms. Order “Initiate Alcohol Withdrawal (CIWA) Protocol.” Order toxicology: Alcohol plasma level, UDS (urine drug screen) acetaminophen level, salicylate level. Concern for Wernicke encephalopathy: Give patient a banana bag at 125ml/hr. Also give IV fluids…

Suicidal

Suicidal patient: Admit to adult special care unit or PCU. Telemetry bed. Initiate suicide precautions including having a ***1-on-1 sitter*** for the patient (suicidal ideation) – pt safety. (If alcohol abuse/withdrawal): Begin Delirium Tremens protocol (see below) Place patient on the CIWA protocol for alcohol withdrawal and monitor closely for symptoms. Order toxicology: alcohol plasma…

Delirium

Delirium: Common in elderly patients, especially hospitalized overnight and/or after large procedures (post-op) (CABG, ortho surgery: hip fracture) – occurs in up to 30% of hospitalized elderly patients. Sx: Confusion, agitation, unable to focus attention, unable to follow commands, rambling incoherently. Alterations in consciousness and cognition with rapid onset over hours to days. Symptoms wax…

Anxiety

Anxiety: (If night float, consider doing only X 1 dose now.) Hydroxyzine Pamoate (Vistaril): antihistamine (Tx: anxiety, tension, nervousness, N/V, allergies, skin rash, pruritis, hives) (do NOT use in elderly) 50mg IM/PO Buspirone (Buspar): Start 15mg “dividose” daily (7.5mg PO bid, increase by 5g/day q 2-3 days to usual effective dose of 30mg/day (Max dose:…

Agitation/Delirium

Agitation/Delirium: Management of delirium: 1st step: Treat reversible causes (ex: antibiotics if infection is known or suspected, pain control) 2nd step: Non-pharmacologic measures: Frequent verbal patient orientation, reassurance, redirect, touch by a familiar (family) member or trained sitter at bedside, environmental modification (visual cues: clock on the wall, curtains open during daytime, date written on…