Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · Feb 1991
ReviewPsychological reaction to hospitalization and illness in the emergency department.
Each personality type presents with different methods of coping. Physicians should be aware of the impact on a patient's psychological functioning and ability to cope with illness and hospitalization, to understand and more effectively manage the patient. The physician must try to assess the patient's baseline personality from their past and present behavior. ⋯ The stress of medical illness and/or hospitalization can be overwhelming for some patients and is usually followed by some form of psychological response. Current understanding of the psychological impact of illness is based upon psychological defenses, coping mechanisms, and individual personality. It is the ability of the emergency physician to identify defenses, coping skills and personality types that will aid him or her in the medical management of the patients in their time of illness and hospitalization.
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Emerg. Med. Clin. North Am. · Feb 1991
ReviewEvaluation of behavioral and cognitive changes: the mental status examination.
Patients who present to the Emergency Department with a behavioral or cognitive disorder should be treated in an organized fashion. The most important element of their care is determining the etiology of their abnormality, whether organic or functional. ⋯ It must be focused and brief. By focusing on seven major areas (affect, attention, language, orientation, memory, visual-spatial ability, and conceptualization), a quick and thorough examination of the patient's mental status can be performed.
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Emergency physicians frequently face death, yet many are unprepared to deal with the family survivors of a patient who has died unexpectedly. Without the benefit of establishing prior rapport with the family, the emergency physician must anticipate the family's grief response so that he or she can intervene to avoid an unnecessarily prolonged or morbid grief reaction. ⋯ Certain key actions in the process of notifying survivors, viewing the body, concluding the emergency department visit, and following up after the patient's death help facilitate survivor grief in the least traumatic way possible. Emergency Departments can improve their dealing with death by instituting a team approach using doctors, nurses, social workers, and clergy to better support family members in their emergency department experience and to provide a link with community service organizations helpful to the family after they leave the hospital.
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Major causes of drug-induced psychoses include cocaine, amphetamines, phencyclidine, cannabinoids, LSD, mescaline, the so-called designer drugs, anticholinergic compounds, and steroids. Most drug-induced psychoses are managed with general supportive measures, reassurance, minimizing patient stimulation, and benzodiazepines as needed; however, specific antidotes such as physostigmine for anticholinergic poisoning or urinary acidification to enhance excretion of amphetamines or phencyclidine may be indicated in some patients. Any patient with a drug-induced psychosis must be evaluated carefully for evidence of other toxic effects of the drug in question.
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Alcoholic ketoacidosis is characterized by a metabolic acidosis with an elevated anion gap. It generally is seen in the chronic alcoholic patient who has recently gone on a "binge" that was terminated because of complaints such as nausea, vomiting or abdominal pain. ⋯ Treatment includes volume repletion and glucose administration. Morbidity and mortality usually result from intercurrent illness.