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dx.
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Interpretation guide
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Acute Psychosis and Mania Symptoms
Resuscitation and Universal Approaches
Approach to Unresponsive Patient
Approach to Airway Obstruction And Stridor
Approach to Acute Respiratory Distress With Impending Failure
Approach to Peri-arrest Hypotension
Approach to Post Resuscitation Care After Rosc
Approach to Cardiac Arrest Rhythms, Pea, Asystole
Approach to Cardiac Arrest Rhythms, Vf, Pulseless Vt
Approach to Severe Agitation With Safety Risk
Approach to Procedural Sedation
Chest and Cardiovascular
Approach to Pacemaker And Icd Related Presentations
Approach to Acute Limb Ischemia And Leg Pain
Approach to Suspected Deep Vein Thrombosis Symptoms
Approach to Hypertension
Approach to Chest Pain
Approach to Palpitations And Tachyarrhythmia Symptoms
Approach to Bradycardia Symptoms
Approach to Syncope And Presyncope
Approach to Syncope With Neurologic Concern
Approach to Unilateral Leg Swelling
Approach to Bilateral Leg Swelling
Approach to Calf Pain And Swelling
Respiratory
Approach to Wheezing, Undifferentiated
Approach to Wheezing In Infants
Approach to Stridor And Upper Airway Symptoms
Approach to Dyspnea
Approach to Aspiration Event
Approach to Cough
Approach to Hemoptysis
Approach to Upper Respiratory Infection Symptoms
Approach to Suspected Pulmonary Embolism Presentation
Approach to Smoke Inhalation Concern
Approach to Smoke Exposure And Inhalational Injury
Abdominal and Gastrointestinal
Approach to Abdominal Distension
Approach to Abdominal Pain, Undifferentiated
Approach to Acute Abdominal Pain (general)
Approach to Suspected Incarcerated Or Strangulated Hernia
Approach to Pancreatitis Concern
Approach to Biliary Colic And Cholecystitis Concern
Approach to Appendicitis Concern
Approach to Diverticulitis Concern
Approach to Rectal Pain And Anorectal Complaints
Approach to Dysphagia And Food Bolus Impaction
Approach to Foreign Body Ingestion
Approach to Refractory Vomiting And Recurrent Vomiting Syndromes
Approach to Cannabis Associated Hyperemesis
Approach to Upper Gastrointestinal Bleeding Symptoms (melena)
Approach to Lower Gastrointestinal Bleeding And Hematochezia
Approach to Constipation And Obstipation
Approach to Diarrhea
Approach to Acute Hepatitis And Jaundice Concern
Approach to Right Upper Quadrant Pain
Approach to Epigastric Pain
Approach to Left Upper Quadrant Pain
Approach to Right Lower Quadrant Pain
Approach to Left Lower Quadrant Pain
Approach to Suprapubic Pain
Renal and Urinary
Approach to Oliguria And Anuria
Approach to Catheter Related Urinary Complaints
Approach to Dialysis Patient Presentations
Approach to Flank Pain And Renal Colic Concern
Approach to Urinary Retention
Approach to Hematuria
Approach to Scrotal Pain
Neurologic
Approach to Transient Neurologic Deficits
Approach to Acute Aphasia And Speech Disturbance
Approach to Acute Confusion And Delirium
Approach to Postictal State And Seizure Recurrence Concern
Approach to Seizure
Approach to Acute Vision Loss
Approach to New Tremor And Involuntary Movements
Approach to Headache
Approach to Vertigo
Approach to Acute Weakness Or Numbness
Approach to Gait Instability And Ataxia
Back and Neck
Approach to Atraumatic Back Pain
Approach to Sciatica And Radicular Back Pain
Approach to Back Pain With Neurologic Deficit, Cauda Equina Concern
Approach to Back Pain With Fever Or Immunosuppression, Spinal Infection Concern
Approach to Atraumatic Neck Pain
Approach to Neck Pain After Trauma
Approach to Neck Pain With Meningismus Concern
Approach to Acute Torticollis
Women's Health, Pregnancy, and GU
Approach to Vaginal Discharge
Approach to Hyperemesis Gravidarum Concern
Approach to Hypertensive Disorders Of Pregnancy Symptoms
Approach to Postpartum Hemorrhage Concern
Approach to Postpartum Infection Concern
Approach to Sexual Assault Medical Evaluation Overview
Approach to Pelvic Pain
Approach to Vaginal Bleeding, Nonpregnant
Approach to Vaginal Bleeding In Pregnancy
Approach to Pelvic Pain In Pregnancy
Approach to Post Procedure Or Post Abortion Complications Concern
Infectious Disease and Fever Syndromes
Approach to Fever In The Immunocompromised Patient
Approach to Fever With Rash
Approach to Animal Bites And Rabies Risk Assessment
Approach to Tick Exposure And Tick Borne Illness Concern
Approach to Sepsis Concern Without Clear Source
Approach to Soft Tissue Infection Concern
Approach to Abscess And Skin Infection Concern
Approach to Sore Throat
Approach to Sore Throat And Pharyngitis Symptoms
Approach to Meningitis
Approach to Envenomation And Bites
Allergy and Dermatology
Approach to Pruritus Without Rash
Approach to Contact Dermatitis And Eczema Flare
Approach to Herpes Zoster Concern
Approach to Drug Eruption Concern And Severe Cutaneous Reaction Red Flags
Approach to Urticaria
Approach to Angioedema Concern
Approach to Unexplained Bruising Or Bleeding Symptoms
Musculoskeletal and Extremities
Approach to Shoulder Pain
Approach to Elbow Pain
Approach to Wrist Pain
Approach to Hand Pain
Approach to Hip Pain
Approach to Knee Pain
Approach to Ankle Pain
Approach to Foot Pain
Approach to Cast Or Splint Complication Symptoms
Approach to Wound Check And Suture Related Visits
Approach to Joint Swelling And Monoarthritis
Approach to Suspected Septic Joint Presentation
Approach to Suspected Tendon Rupture Presentation
Approach to Limp Or Refusal To Bear Weight
Trauma and Wounds
Approach to Motor Vehicle Collision Evaluation
Approach to Chest Wall Trauma And Rib Injury
Approach to Blunt Abdominal Trauma Evaluation
Approach to Penetrating Trauma Evaluation
Approach to Pediatric Minor Head Trauma
Approach to Pediatric Head Trauma
Approach to Facial Lacerations And Dental Trauma
Approach to Hand Lacerations With Tendon Injury Concern
Approach to Puncture Wounds And Retained Foreign Body Concern
Approach to Electrical Injury
Approach to Burn Injury
Approach to Fall Evaluation
Approach to Assault And Interpersonal Violence Evaluation
Approach to Eye Trauma And Hyphema Concern
ENT, Eye, Dental
Approach to Dysphagia And Odynophagia
Approach to Throat Pain
Approach to Ear Pain
Approach to Foreign Body In Ear Or Nose
Approach to Vision Loss Complaint
Approach to Flashes And Floaters
Approach to Atraumatic Eye Pain
Approach to Red Eye
Approach to Dental Abscess Concern
Approach to Post Extraction Pain And Complications
Endocrine, Metabolic, and Abnormal Labs
Approach to Hyperglycemia
Approach to Hypoglycemia
Approach to Hyponatremia Symptoms
Approach to Hyperkalemia Symptoms
Approach to Hypokalemia Symptoms
Approach to Rhabdomyolysis Concern
Approach to Anticoagulation Related Abnormal Coagulation Studies
Approach to Acute Kidney Injury And Elevated Creatinine Referral
Approach to Symptomatic Anemia Concern
Toxicology and Behavioral
Approach to Undifferentiated Overdose
Approach to Opioid Toxicity
Approach to Opioid Withdrawal
Approach to Alcohol Intoxication
Approach to Alcohol Withdrawal
Approach to Stimulant Toxicity
Approach to Pediatric Ingestion
Approach to Carbon Monoxide Exposure
Approach to Inhalational Or Chemical Exposure
Approach to Suicidal Ideation And Self Harm Risk Assessment
Approach to Acute Psychosis And Mania Symptoms
Approach to Anxiety And Panic Symptoms
Approach to Capacity Assessment And Safe Disposition
Approach to Behavioral Escalation And Restraint Considerations
Pediatrics
Approach to Fever In The Neonate And Young Infant
Approach to Pediatric Fever By Age 0 To 28 Days
Approach to Pediatric Fever By Age 29 To 60 Days
Approach to Pediatric Fever By Age 2 To 24 Months
Approach to Pediatric Respiratory Distress
Approach to Croup And Stridor In Children
Approach to Pediatric Dehydration
Approach to Pediatric Abdominal Pain
Approach to Febrile Seizure
Approach to Rash In The Child
Approach to Poor Feeding And Lethargy In The Infant
Approach to Vomiting In The Child
Approach to Diarrhea In The Child
Approach to Pediatric Trauma Evaluation
Approach to Brief Resolved Unexplained Event In The Infant And Apparent Life Threatening Event Concern
Approach to Lethargy And Altered Mental Status In The Child
Environmental and Exposure
Approach to Heat Illness
Approach to Hypothermia And Cold Exposure
Approach to Frostbite Concern
Approach to Drowning And Submersion Injury
Acute Psychosis and Mania Symptoms
POCUS
Procedures
Calculators
Resuscitation
ECG Guide
Back
Clinical Assessment Checklist
Browse categories and answer follow-up questions to refine your symptom profile.
History
Presenting features
Symptom characterization
▶
Onset pattern
▶
Sudden
Subacute
Gradual
Time course
▶
Hours
Days
Weeks
Primary symptoms
▶
Agitation
Insomnia
Disorganized behavior
Hallucinations
Delusions
Pressured speech
Grandiosity
Flight of ideas
Distractibility
Increased goal directed activity
Associated symptoms
Associated symptoms
▶
Autonomic
▶
Fever
Diaphoresis
Tremor
Neurologic
▶
Headache
Seizure
Focal deficit
Medical
▶
Chest pain
Dyspnea
Abdominal pain
Precipitants and context
Triggers and context
▶
Sleep deprivation
▶
Recent nights without sleep
Shift work
Psychosocial
▶
Recent loss
Acute stress
Substance related
▶
Intoxication
Withdrawal
Prior episodes and baseline
Baseline and prior episodes
▶
Prior mania
▶
Prior hospitalization
Prior response to mood stabilizer
Prior psychosis
▶
First episode psychosis
Known schizophrenia spectrum disorder
Functional impact
Function and safety impact
▶
ADLs
▶
Eating and hydration
Self care
Safety
▶
Wandering
Reckless spending
Driving risk
Alarm Features
Immediate escalation triggers
Resuscitation triggers
▶
Airway risk
▶
Inability to protect airway
Recurrent emesis with reduced consciousness
Breathing risk
▶
SpO2 less than 92 percent on room air
Respiratory rate greater than 30 per minute
Circulation risk
▶
Systolic BP less than 90 mmHg
HR greater than 130 per minute with instability
Temperature
▶
Temperature 38.5 C or higher with rigidity
Temperature 40 C or higher
High risk medical causes
Life threatening differentials
▶
Delirium
▶
Fluctuating attention
Disorientation
CNS infection
▶
Fever
Neck stiffness
Intracranial catastrophe
▶
Thunderclap headache
New focal deficit
Toxicologic emergency
▶
Severe agitation with hyperthermia
Refractory tachycardia and hypertension
Violence and incapacity
Safety threats
▶
Imminent violence risk
▶
Weapons access
Uncontrolled aggression
Grave disability
▶
Unable to maintain hydration
Unable to obtain shelter
High risk medication syndromes
Iatrogenic syndromes
▶
Neuroleptic malignant syndrome
▶
Lead pipe rigidity
Elevated CK
Serotonin syndrome
▶
Hyperreflexia
Clonus
Medications
Current medications
Medication inventory
▶
Psychiatric
▶
Antipsychotics
Antidepressants
Mood stabilizers
Medical
▶
Steroids
Thyroid hormone
Dopaminergic agents
Recent changes and adherence
Recent medication changes
▶
New start
▶
Antidepressant start or dose increase
Steroid start or dose increase
Discontinuation
▶
Benzodiazepine stop
Alcohol stop
Nonadherence
▶
Missed antipsychotic doses
Missed mood stabilizer doses
High risk interactions and contraindications
Interaction traps
▶
QT prolonging combinations
▶
Antipsychotic plus macrolide
Antipsychotic plus fluoroquinolone
CNS depressant stacking
▶
Benzodiazepine plus opioid
Benzodiazepine plus alcohol
ED medications likely to be used
Acute agitation medications
▶
Lorazepam
▶
Adult dose 1 mg to 2 mg PO or IV or IM
Repeat every 10 to 20 minutes to effect
Midazolam
▶
Adult dose 5 mg IM
Repeat 5 mg IM once if needed
Haloperidol
▶
Adult dose 2.5 mg to 5 mg IM or IV
Repeat every 15 to 30 minutes to effect
Olanzapine
▶
Adult dose 5 mg to 10 mg IM
Avoid IM benzodiazepine within 1 hour
Droperidol
▶
Adult dose 2.5 mg to 5 mg IM or IV
QTc monitoring local protocol dependent
Ketamine
▶
Adult dose 4 mg/kg IM for severe excited delirium
Airway readiness required
Diet
Intake and hydration
Recent intake
▶
Poor oral intake
▶
Reduced food
Reduced fluids
Dehydration risk
▶
Vomiting
Diarrhea
Caffeine and stimulants
Stimulant exposure
▶
Caffeine
▶
Coffee
Energy drinks
Supplements
▶
Pre workout products
Weight loss products
Alcohol
Alcohol pattern
▶
Recent heavy use
▶
Binge drinking
Daily use
Cessation timing
▶
Last drink
Prior withdrawal seizures
Review of Systems
Constitutional and infection
System review
▶
Constitutional
▶
Fever
Weight loss
Infection clues
▶
Cough
Dysuria
Cardiopulmonary
Cardiopulmonary
▶
Cardiac
▶
Chest pain
Palpitations
Respiratory
▶
Dyspnea
Hypoxia symptoms
Neurologic
Neurologic
▶
Seizure
▶
Witnessed convulsions
Post ictal confusion
Headache
▶
Sudden severe
Progressive
Endocrine
Endocrine
▶
Thyrotoxicosis symptoms
▶
Heat intolerance
Weight loss with appetite
Hypoglycemia symptoms
▶
Diaphoresis
Tremor
Psychiatric
Psychiatric symptoms
▶
Mood
▶
Elevated mood
Irritability
Psychosis
▶
Hallucinations
Delusions
Collateral History and Family History
Collateral source and reliability
Collateral data
▶
Source
▶
Family
EMS
Police
Shelter staff
Reliability
▶
Direct witness
Second hand report
Family history
Family psychiatric history
▶
Bipolar disorder (F31)
▶
First degree relative
Age of onset
Schizophrenia spectrum (F20)
▶
First degree relative
Prior hospitalizations
Social support and supervision
Support
▶
Safe supervision available
▶
Responsible adult
Ability to monitor meds
Housing stability
▶
Stable housing
Unhoused
Risk Factors
Substance and withdrawal risk
Substance risks
▶
Stimulants
▶
Cocaine
Methamphetamine
Hallucinogens
▶
LSD
PCP
Withdrawal
▶
Alcohol withdrawal risk
Benzodiazepine withdrawal risk
Medical and neurologic risk
Medical causes risk
▶
CNS disease
▶
Seizure disorder (G40)
Brain tumor history (C71)
Endocrine
▶
Hyperthyroidism (E05.90)
Adrenal disease
Medication related risk
Medication risks
▶
Steroid induced mood symptoms
▶
Prednisone equivalent high dose
Recent burst
Serotonergic load
▶
SSRI plus MAOI
SSRI plus linezolid
Special populations
High risk populations
▶
Pregnancy
▶
New onset psychosis
Postpartum period
Older adult
▶
Delirium risk
Polypharmacy
Differential Diagnosis
Life threatening
Life threatening
▶
Delirium (F05)
▶
Fluctuating attention
Disorganized thinking
Meningitis or encephalitis (G03.9)
▶
Fever
Neck stiffness
Intracranial hemorrhage (I61.9)
▶
Sudden severe headache
Focal neurologic deficit
Hypoglycemia (E16.2)
▶
Low bedside glucose
Rapid symptom reversal with glucose
Thyroid storm (E05.91)
▶
Hyperthermia
Tachycardia
Neuroleptic malignant syndrome (G21.0)
▶
Rigidity
Elevated CK
Serotonin syndrome (T43.225A)
▶
Clonus
Hyperreflexia
Common
Common
▶
Bipolar I disorder manic episode (F31.1)
▶
Decreased need for sleep
Increased goal directed activity
Substance induced psychotic disorder (F19.959)
▶
Temporal relation to use
Improvement with clearance
Schizophrenia (F20.9)
▶
Chronic functional decline
Negative symptoms
Major depressive disorder with psychotic features (F32.3)
▶
Depressive syndrome
Mood congruent psychosis
Less common
Less common
▶
Autoimmune encephalitis (G04.81)
▶
New onset seizures
Dyskinesias
Temporal lobe epilepsy (G40.209)
▶
Episodic fear
Post event confusion
Porphyria (E80.21)
▶
Abdominal pain
Neuropathy
Wilson disease (E83.01)
▶
Liver disease
Psychiatric symptoms in young adult
Past Medical History
Psychiatric history
Prior psychiatric diagnoses
▶
Bipolar disorder (F31)
▶
Prior manic episodes
Prior mood stabilizer response
Schizophrenia spectrum (F20)
▶
Baseline function
Prior antipsychotic response
Medical history
Medical history relevant
▶
Epilepsy (G40)
▶
Last seizure
Antiseizure adherence
Thyroid disease
▶
Hyperthyroidism history
Recent dose changes
Procedures and hospitalizations
Prior hospital care
▶
ICU history
▶
Intubation for agitation
Severe toxidrome
Recent ED visits
▶
Similar presentation
Disposition outcomes
Physical Exam
General and vitals pattern
General and vitals
▶
Appearance
▶
Toxic appearing
Diaphoretic
Vital signs
▶
Temperature
HR
BP
RR
SpO2
Mental status and behavior
Mental status
▶
Level of consciousness
▶
Alert
Somnolent
Obtunded
Attention
▶
Able to sustain attention
Distractible
Thought process
▶
Linear
Tangential
Disorganized
Perception
▶
Auditory hallucinations
Visual hallucinations
Neurologic
Neurologic
▶
Pupils
▶
Mydriasis
Miosis
Motor
▶
Rigidity
Tremor
Reflexes
▶
Hyperreflexia
Clonus
Focal deficits
▶
Facial droop
Limb weakness
Cardiopulmonary and hydration
Cardiopulmonary and volume
▶
Heart and lungs
▶
Arrhythmia signs
Wheeze
Hydration
▶
Dry mucous membranes
Poor skin turgor
Key pitfalls
Pitfalls
▶
Delirium mistaken for primary psychiatric
▶
Disorientation
Fluctuating course
Catatonia missed
▶
Stupor
Waxy flexibility
Lab Studies
Core ED labs
Initial labs
▶
Point of care glucose
▶
Immediate if altered mental status
Repeat after sedation if concern persists
CBC
▶
Leukocytosis
Anemia
CMP
▶
Sodium abnormalities
Renal dysfunction
CK
▶
Rhabdomyolysis risk with severe agitation
Trend if elevated
Toxicology and metabolic
Toxicology and metabolic
▶
Serum ethanol
▶
Intoxication assessment
Withdrawal risk stratification
Urine drug screen
▶
Limited specificity
False positives possible
Acetaminophen level
▶
Co ingestion screening
Timing dependent interpretation
Infection and endocrine
Infection and endocrine labs
▶
TSH
▶
Hyperthyroidism screen
Consider free T4 if abnormal
Urinalysis
▶
UTI in older adults
Ketones with starvation
Blood cultures
▶
If fever with suspected sepsis
Local protocol dependent
Pregnancy and special tests
Special population labs
▶
Pregnancy test
▶
All patients with pregnancy potential
Impacts medication choice
Lithium level
▶
If on lithium
Toxicity screen
Imaging
Scoring Systems
Scoring and monitoring tools
▶
Richmond Agitation Sedation Scale
▶
Target calm and arousable
Trend after medication
CIWA Ar
▶
Alcohol withdrawal severity
Not validated in delirium or severe agitation
COWS
▶
Opioid withdrawal severity
Guides buprenorphine pathway local protocol dependent
4AT
▶
Delirium screen
Not a replacement for clinical assessment
Bush Francis Catatonia Rating Scale
▶
Catatonia screen
Lorazepam challenge supports diagnosis
MRI
MRI brain
▶
Indications
▶
Suspected encephalitis with non diagnostic CT
New focal neurologic deficit
Contraindications
▶
Non MRI compatible implant
Unstable airway or hemodynamics
Protocol notes
▶
With and without contrast for encephalitis
Consider diffusion sequences for stroke
CT
CT head
▶
Indications
▶
New focal neurologic deficit
New severe headache
Seizure with persistent altered mental status
Limitations
▶
Early encephalitis may be normal
Does not exclude intoxication or withdrawal
Contrast cautions
▶
Renal impairment risk
Allergy history
Ultrasound
Ultrasound
▶
POCUS applications
▶
Bladder volume for urinary retention with delirium
IVC assessment for volume status adjunct
Limitations
▶
Not diagnostic for primary psychiatric illness
Operator dependent findings
Special Tests
Bedside and procedural diagnostics
Additional diagnostics
▶
Lumbar puncture
▶
If suspected meningitis or encephalitis
CT head first if focal deficit or papilledema concern
EEG
▶
Nonconvulsive status epilepticus concern
Persistent altered mental status after sedation wears off
Lorazepam challenge
▶
Catatonia suspected
Improvement supports diagnosis
Toxicology and exposure focused
Targeted tests
▶
Serum osmolality
▶
Toxic alcohol concern
Osmolar gap interpretation limitations
Carboxyhemoglobin
▶
CO exposure concern
Pulse oximetry may be misleading
ECG
Indications and monitoring
ECG use
▶
Baseline ECG
▶
Before QT prolonging antipsychotic when feasible
After large cumulative doses
QTc monitoring
▶
QTc 500 ms or greater high risk
Correct electrolytes if QTc prolonged
Key patterns
ECG patterns
▶
Sympathomimetic toxicity
▶
Sinus tachycardia
Ischemic changes
TCA toxicity concern
▶
QRS widening
Terminal R in aVR
Assessment
Syndrome framing
Working problem list
▶
Acute psychosis
▶
Primary psychiatric vs secondary medical
First episode psychosis pathway
Manic episode
▶
Bipolar I manic episode (F31.1)
Substance induced mania (F19.94)
Delirium concern
▶
Fluctuating attention and awareness
Medical trigger likely
Severity stratification
Severity and risk
▶
Agitation level
▶
Cooperative
Uncooperative but redirectable
Violent or severely agitated
Medical instability
▶
Hyperthermia
Hypoxia
Complications
▶
Rhabdomyolysis risk
Aspiration risk
Plan
First 5 minutes
Immediate workflow
▶
Safety
▶
Staff safety and security presence
De escalation attempt if safe
Monitoring
▶
Cardiac monitor
SpO2 monitoring
Temperature trend
Access
▶
IV access if cooperative
IM plan if unsafe for IV
Rapid reversible checks
▶
Bedside glucose
SpO2 and ventilation status
Sedation strategy
Acute agitation management
▶
Medication choice by suspected cause
▶
Sympathomimetic intoxication
▶
Benzodiazepine first line
Avoid beta blocker monotherapy
Primary psychosis or mania
▶
Antipsychotic or benzodiazepine
Avoid oversedation
Alcohol withdrawal
▶
Benzodiazepine first line
Thiamine 100 mg IV or IM before glucose if malnourished
Dosing examples
▶
Lorazepam 1 mg to 2 mg PO or IV or IM
Haloperidol 2.5 mg to 5 mg IM or IV
Olanzapine 5 mg to 10 mg IM
Do not do items
▶
Olanzapine IM plus benzodiazepine IM within 1 hour
Physical restraint without sedation plan and monitoring
Diagnostic sequencing
Diagnostic plan
▶
Focused medical screen
▶
Glucose
CMP
CBC
Targeted additions by features
▶
Fever
▶
Blood cultures
LP pathway
Rigidity or hyperthermia
▶
CK
Consider NMS or serotonin syndrome
Reassessment loop
Reassessment
▶
Timing
▶
Every 15 minutes until calm and stable
After each medication dose
Elements
▶
Airway and RR
Vital sign trend
Agitation scale trend
Escalation triggers
▶
Persistent severe agitation after 2 medication rounds
Rising temperature or CK
Disposition
ICU or monitored bed criteria
Higher level of care
▶
ICU indications
▶
Hyperthermia with toxidrome
Need for intubation
Stepdown or monitored bed
▶
QTc 500 ms or greater with ongoing antipsychotic need
Significant electrolyte abnormality
Medical admission criteria
Medical admission
▶
Delirium
▶
Identified medical trigger
Persistent inattention
Rhabdomyolysis
▶
CK significantly elevated
AKI or rising creatinine
Psychiatric admission criteria
Psychiatric admission
▶
Acute psychosis or mania with impaired judgment
▶
Unable to care for basic needs
Unsafe behavior
First episode psychosis
▶
Need for diagnostic workup
Need for close follow up reliability uncertain
Discharge criteria
Copy
Discharge
▶
Clinical stability
▶
Calm and cooperative
No medical red flags on evaluation
Support and follow up
▶
Safe supervision
Rapid outpatient follow up arranged
Discharge Instructions
Copy discharge instructions
Copy
Discharge text
▶
Today you were seen for changes in thinking and behavior
Your tests did not show an emergency medical cause that needs admission today
Avoid alcohol and recreational drugs
Do not drive until cleared by your clinician
Take medications exactly as prescribed
Follow up within 24 to 72 hours with psychiatry or your primary clinician
Return to the emergency department now for
▶
Fever
Severe headache
Seizure
Chest pain
Trouble breathing
Worsening confusion
Uncontrolled agitation
References
Guidelines and key sources
Evidence based sources
▶
American Psychiatric Association practice guideline for the treatment of patients with schizophrenia 2020
American Psychiatric Association practice guideline for the treatment of patients with bipolar disorder update 2023 local protocol dependent
ACEP clinical policy on the adult psychiatric patient in the emergency department 2017
Project instructions file
▶
/mnt/data/approach_chatgpt_instructions.rtf
Internal formatting and safety rules
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.
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Clinical Approaches
Acute Psychosis and Mania Symptoms