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Chapter 23 Behavioral Emergencies

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Behavioral Emergencies

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Chapter 23 Behavioral Emergencies

  1. 1. Chapter 23 Behavioral Emergencies
  2. 2. Behavioral Emergencies (1 of 3) • Behavior is how a person acts. • Abnormal behavior may be due to a psychological or a physical condition. • Behavior that leads to violence or other inappropriate activities is known as a behavioral emergency.
  3. 3. Behavioral Emergencies (2 of 3) • Several factors can change behavior: • Situational stresses • Medical illnesses • Psychiatric problems • Alcohol • Drugs
  4. 4. Behavioral Emergencies (3 of 3) • Common reasons for behavioral changes: • Low blood glucose level • Lack of oxygen • Inadequate blood flow to the brain • Head trauma • Excessive cold or heat • Mind-altering substances • Psychogenic or psychiatric illness
  5. 5. Depression • One of the most common and treatable mental illnesses • Types: • Reactive • Major or clinical • Bipolar • Due to chemical imbalance in the brain
  6. 6. Recognizing Depression (1 of 3) • Persistent sad, anxious, or empty moods • Feelings of hopelessness, pessimism • Feelings of guilt, worthlessness, helplessness • Loss of interest in hobbies and activities that were once enjoyed • Decreased energy, fatigue
  7. 7. Recognizing Depression (2 of 3) • Difficulty concentrating, remembering, making decisions • Insomnia, early-morning awakening, oversleeping • Appetite and/or weight loss or overeating and weight gain
  8. 8. Recognizing Depression (3 of 3) • Thoughts of death or suicide; suicide attempts • Restlessness, irritability • Persistent physical symptoms that do not go away with treatment
  9. 9. Care for Depression • Say, “You look very sad.” • Do not discourage crying. • Show concern. • Interview in private. • Ask open-ended questions. • State that many people have periods of unhappiness, but can be helped • Mention community resources.
  10. 10. Suicide (1 of 6) • Any willful act that ends one’s life • Each year, about 30,000 Americans commit suicide. • Eleventh reported leading cause of death in the United States • More than three times more likely in men
  11. 11. Suicide (2 of 6) • Common methods: • Firearms • Hanging • Poisoning by solids or liquids • Jumping from high places • Carbon monoxide poisoning • Drowning • Self-inflicted wounds
  12. 12. Suicide (3 of 6) • Peaks during spring months • Lowest in Northeast; highest in mountain states • About 60% of victims have previously attempted suicide • Try to keep suicidal person on phone until EMS reaches scene
  13. 13. Suicide (4 of 6) • If you encounter a suicidal person: • Remove any dangerous articles. • Talk quietly with the person. • Encourage discussion.
  14. 14. Suicide (5 of 6) • If you encounter a suicidal person (cont’d): • Ask: • Have you attempted suicide before? • Have you made concrete plans for a method? • Has any family member committed suicide? • Reassure person and take them to medical help • Do not leave them alone under any circumstances
  15. 15. Suicide (6 of 6) • When a person attempts suicide: • First aid care has priority. • Drug overdoses must be managed. • Bleeding must be controlled. • If a drug overdose is involved: • Collect medication containers, pills, or other drugs found on the scene. • Law enforcement should be contacted.
  16. 16. Recognizing a Potential Suicide Victim (1 of 2) • Gets affairs in order • Gives away articles of value • Exhibits signs of planning a suicide • Obtaining a weapon • Writing a suicide note
  17. 17. Recognizing a Potential Suicide Victim (2 of 2) • May say: • Life isn’t worth living. • My family would be better without me. • Next time, I’ll take enough pills. • Take my valuables. • I won’t be around to deal with that. • You’ll be sorry when I’m gone. • I won’t be around much longer. • Life’s too hard. • Nobody understands me. • I can’t make it better. • I’d be better off dead. • I feel like there is no way out.
  18. 18. Care for a Potential Suicide Victim (1 of 2) • Be direct. • Be willing to listen. • Be nonjudgmental. • Get involved. • Do not dare him or her to do it. • Do not act shocked.
  19. 19. Care for a Potential Suicide Victim (2 of 2) • Do not be sworn to secrecy. • Offer hope that alternatives are available. • Take action. • Get help from persons or agencies.
  20. 20. Emotional Injury • First aid for an emotional “injury” means being supportive. • Although most emotional reactions are temporary, they are seriously disabling and may upset others.
  21. 21. Typical Reactions • Common in the face of an emergency: • Feeling shaky • Perspiring profusely • Becoming nauseated • Determine whether a person needs help. • Do not be impatient, intolerant, or resentful. • Do not be overly sympathetic or overly solicitous.
  22. 22. Recognizing Aggressive, Hostile, and Violent Behavior (1 of 2) • Size up the situation before you do anything. • Does the person have clenched fists? • Is he or she holding a weapon? • Is the person yelling? • Is the person verbally threatening harm?
  23. 23. Recognizing Aggressive, Hostile, and Violent Behavior (2 of 2) • If the scene is unsafe, do not enter. • Contact law enforcement officers. • Encourage the person to speak about cause of anger • Notify police if you are unable to communicate with person
  24. 24. Care for Aggressive, Hostile, and Violent Behavior (1 of 2) • Acknowledge that the person seems upset. • Maintain a comfortable distance. • Encourage the person to state what is troubling him or her. • Do not make quick moves. • Respond to the person’s questions. • Do not threaten, challenge, or argue
  25. 25. Care for Aggressive, Hostile, and Violent Behavior (2 of 2) • Tell the truth — do not lie. • Do not “play along” with the person. • Involve trusted family members or friends. • Be prepared to stay with the person. • Never leave the person alone. • Avoid unnecessary physical contact. • Maintain eye contact.
  26. 26. Sexual Assault and Rape (1 of 2) • Rape is forcible sexual intercourse without the consent of one participant. • Categories include: • Acquaintance rape • Date rape • Marital rape • Stranger rape
  27. 27. Sexual Assault and Rape (2 of 2) • The victim may hesitate to report a rape. • Shame • Guilt • Fear of retaliation • Reluctance to deal with law enforcement • Doubt that a “real” rape occurred
  28. 28. Care for a Rape or Sexual Assault Victim • Be tactful and sensitive. • Convince the victim to seek counseling. • Ask victim not to change clothes or bathe. • Suggest that the victim not urinate, douche, defecate, or wash before being examined. • Care for any injuries.
  29. 29. Child Abuse and Neglect (1 of 2) • More than 2.5 million cases of child abuse and neglect cases are reported each year. • 35% involve physical abuse • 15% involve sexual abuse • 50% involve neglect
  30. 30. Child Abuse and Neglect (2 of 2) • Physical effects: • Damage to the brain and vital organs • Damage to eyes, ears, arms and legs • Major categories: • Physical abuse • Neglect • Sexual abuse • Emotional maltreatment
  31. 31. Recognizing Child Abuse and Neglect (1 of 4) • Be alert to unexplainable changes in behavior. • Physical abuse: • Any injury that cannot be explained Courtesy of Ron Dieckmann, M.D. Courtesy of Ron Dieckmann, M.D. Courtesy of Ron Dieckmann, M.D.
  32. 32. Recognizing Child Abuse and Neglect (2 of 4) • Sexual abuse: • Fearful behavior • Abdominal pain • Bedwetting • Urinary tract infection • Genital pain or bleeding • Sexually transmitted disease • Sexual behavior inappropriate for child’s age
  33. 33. Recognizing Child Abuse and Neglect (3 of 4) • Emotional abuse: • Sudden change in self-confidence • Headaches or stomachaches with no medical cause • Abnormal fears • Increased nightmares • Attempts to run away
  34. 34. Recognizing Child Abuse and Neglect (4 of 4) • Emotional neglect: • Failure to gain weight • Desperately affectionate behavior • Large appetite and stealing of food
  35. 35. Care for Child Abuse and Neglect • Give appropriate first aid for injuries. • Do not accuse parents or caregivers. • Report any suspected abuse to the local welfare and social service agency.
  36. 36. Domestic Violence • Also known as partner abuse, spouse abuse, or battering • Occurs when one person inflicts injury, either emotional or physical, upon another person with whom they had or have a relationship
  37. 37. Recognizing Domestic Violence (1 of 3) • Physical domestic violence: • Slapping • Punching • Kicking • Choking • Shooting • Stabbing • Bludgeoning
  38. 38. • Injuries that should raise suspicion: • Bruises or injuries on the head, neck, or chest • Type/extent of injury inconsistent with explanation • Substantial delay between injury occurrence and seeking of help Recognizing Domestic Violence (2 of 3)
  39. 39. Recognizing Domestic Violence (3 of 3) • Injuries that should raise suspicion (cont’d): • Injuries during pregnancy • Evidence of alcohol or drug abuse • Needs medical care as a result of a suicide attempt or rape
  40. 40. Care for Domestic Violence • If you are not aware of immediate danger, but suspect abuse, check with social service agencies. • Call the police if the person is in immediate danger. • First aid includes calling 9-1-1 and treating any injuries.
  41. 41. Elder Abuse • Ranges from passive neglect to active assault • Occurs most often in women older than 75 years
  42. 42. Recognizing Elder Abuse (1 of 3) • Physical injury: • Bruises • Cuts • Burn or rope marks • Broken bones that cannot be explained • Sudden changes in behavior • Comments about being battered • Refusal of the caregiver to allow you to visit the older person alone
  43. 43. Recognizing Elder Abuse (2 of 3) • Lack of physical care: • Dehydration • Malnourishment • Weight loss • Poor hygiene • Bed sores • Soiled bedding • Unmet medical needs • Comments about being mistreated
  44. 44. Recognizing Elder Abuse (3 of 3) • Unusual behaviors: • Agitation • Withdrawal • Fear or anxiety • Apathy • Reports of being treated improperly
  45. 45. Care for Elder Abuse • If you are not aware of immediate danger, but you suspect abuse, check with social service agencies. • If you suspect abuse in institutional setting, report to state ombudsman • Call police if person is in imminent danger • First aid includes calling 9-1-1 when needed and treating any injuries.

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