Protocol Detail
SUICIDAL IDEATION
Suicidal ideation, also known as suicidal thoughts, is thinking about or having an unusual preoccupation with suicide.
Diagnosis
Frequent presenting complaint in the Emergency Department either through attempts at suicide or by expression of thought.
Take events seriously.
Treatment & admission only to be forced in uncooperative patients where the act of self-harm is truly life threatening or the patients are a in danger to themselves or others.
Suicidality scale (“SAD PERSONS HERE”):
1. Sex- male,
2. Age < 25 or >45,
3. Depression,
4. Previous attempt,
5. Ethanol & drug abuse,
6. Rational thinking disturbances,
7. Social support lacking,
8. Organized plan,
9. No spouse,
10. Sickness,
11. Hopelessness,
12. Employment, unemployed > 2 years,
13. Recent loss,
14. Early parental loss.
Score 1 point for each item.
· 10 – High risk, Psychiatric review urgently, hospital admission likely,
· 6-10- Moderate nrisk, psychiatric assessment mandatory,
· <6 – Low risk, Psychiatric assessment preferred but discharge & expedient LMO review might be acceptable.
Lethality factor (“IPMO”):
· Intention
· Plan,
· Motivation,
. Opportunity
Management
1. Consider sedation with Diazepam IV 10 mg, Midazolam 5-15 IV por Haloperidol 10 mg IV (or 5-10 mg IM as a single dose),
2. Above doses may be repeated after 5 minutes if inadequate response.
3. Droperido 10-20mg IM is a fast acting IM alternative if IV access is not possible,
4. Hospital admission might be required if high risk or lethality factors,
5. May need to recommend for involuntary treatment if non-co-operative.
6. If there is associated underlysing mental illness admission might be required for treatment of this,
7. Liaise with Psychiatric & medical officer.
Recent Protocols
COVID 19
COVID 19 is a disease caused by the most recently discovered coronavirus which is a large family of corona viruses causing illnesses. In humans it causes Respiratory infections for example Severe Acute Respiratory Disease (SARs) PRESENTATION Fever 77-98% Cough 46-82% Myalgia/Fatigue 11-52% Shortness of breath 3-31% Incubation period 14 days, most people develop symptoms between 5-6ays from exposure Stage1 (Early infection). Stage 2. Stage 3(Hyperinflation phase) Viral response---------------------------Pulmonary Phase----------------------Host Response *Anyone presenting with flu like symptoms should be assumed to be a COVID 19 case until proven otherwise*
WARFARIN OVERDOSE/ TOXICITY
Overdose of the oral anticoagulant warfarin (Coumadin), or drug interactions with warfarin, can lead to toxicity. Similarly, toxicity can result from exposure to superwarfarins, which are long-acting anticoagulants used in rodenticides. ... Warfarin is the most common oral anticoagulant in current use
SPINAL CORD INJURY
Emergency signs and symptoms of a spinal cord injury after an accident may include: Extreme back pain or pressure in your neck, head or back. Weakness, incoordination or paralysis in any part of your body. Numbness, tingling or loss of sensation in your hands, fingers, feet or toes. Loss of bladder or bowel control.
SNAKE ENVENOMATION
snake envenomation causes headache, a thick feeling of the tongue, thirst, sweating and vomiting
SEROTONIN SYNDROME
Serotonin syndrome (SS) is a group of symptoms that may occur following use of certain serotonergic medications or drugs. The degree of symptoms can range from mild to severe. Symptoms include high body temperature, agitation, increased reflexes, tremor, sweating, dilated pupils, and diarrhea.
