Browse categories and answer follow-up questions to refine your symptom profile.
Approach to the Critical Patient
Immediate safety and stabilization
Immediate safety priorities
Environment free of ligature risks
Removal of belts
Removal of cords
Continuous observation level
1 to 1 sitter for active intent
Line of sight for moderate risk
Security support
Elopement risk plan
Agitation escalation plan
ABCs and vitals
Airway protection threshold
Hemodynamic instability triggers
Capacity and consent
Decisional capacity concerns
Substitute decision maker needs
Time critical medical threats after attempt
Medical emergency triggers
Depressed level of consciousness
Immediate resuscitation bay
Airway management pathway
Respiratory depression
Bag valve mask readiness
Naloxone pathway for suspected opioid toxicity
Shock physiology
IV access and fluids
Hemorrhage control if trauma
Hyperthermia
Active cooling
Serotonin syndrome differential
Seizure activity
Benzodiazepine first line
Glucose check
Agitation and violence risk
Behavioral emergency pathway
Verbal de escalation
Calm tone and simple choices
Reduce stimulation
Medication for severe agitation
Antipsychotic options per local protocol
Benzodiazepine options per local protocol
Restraints
Last resort
Time limited and monitored
Medical causes of agitation
Hypoxia
Hypoglycemia
Consultation and team activation
Early consult triggers
Psychiatry or crisis team
Active plan or intent
Recent attempt
Toxicology
Suspected ingestion
Unknown substance exposure
Social work
Unsafe home environment
Child protection concerns
Pediatrics or adolescent medicine
Age under local adult threshold
Developmental vulnerability
History
Presenting crisis details
Current suicidal thoughts
Intensity and frequency
Passive death wish
Active intent
Plan characteristics
Specificity
Immediacy
Preparatory behaviors
Giving away possessions
Farewell messages
Protective factors
Reasons for living
Future oriented goals
Attempt and self harm history
Suicide attempt history
Number and recency
Within 24 hours
Within 1 month
Lethality indicators
Expectation of death
Interrupted versus aborted attempt
Medical consequences
Loss of consciousness
Need for medical treatment
Prior self injurious behavior
Non suicidal self injury
Escalation pattern
Mental health and substance history
Psychiatric history
Major depressive episode features
Anhedonia
Hopelessness
Psychosis features
Command hallucinations
Delusional guilt
Mania or hypomania features
Decreased need for sleep
Impulsivity
Anxiety and trauma features
Panic symptoms
PTSD symptoms
Substance use history
Alcohol use pattern
Recent intoxication
Withdrawal risk
Drug use pattern
Stimulants
Opioids
Substance related disinhibition
Blackouts
Impaired judgment
Social context and access to means
Psychosocial stressors
Relationship conflict
Breakup
Family conflict
Academic or work stress
Failure or suspension
Job loss
Legal or financial stress
Charges
Housing insecurity
Access to lethal means
Medications at home
Large quantities
High risk medications
Sharps
Unsecured blades
Tools
Firearms access
In home
In relatives home
Past care and engagement
Prior treatment
Psychiatric hospitalization
Voluntary
Involuntary
Therapy engagement
Current therapist
Missed appointments
Medication adherence
Recent changes
Side effects
Safety planning history
Prior plan use
Barriers to use
Physical Exam
General and neurologic
Global assessment
Appearance and distress
Psychomotor agitation
Psychomotor retardation
Vital signs
Fever
Hypotension
Level of consciousness
AVPU status
GCS threshold for escalation
Neurologic exam
Pupils
Focal deficits
Mental status exam
Mental status domains
Speech and thought process
Pressured speech
Thought blocking
Mood and affect
Hopeless affect
Labile affect
Thought content
Suicidal intent
Homicidal ideation
Perception
Hallucinations
Dissociation
Insight and judgment
Poor insight
Impulsivity
Signs of intoxication or toxidrome
Toxidrome screening
Opioid toxidrome
Miosis
Bradypnea
Anticholinergic toxidrome
Dry mucosa
Tachycardia
Sympathomimetic toxidrome
Diaphoresis
Hyperreflexia
Serotonin toxicity
Clonus
Hyperthermia
Trauma and medical complications
Trauma screening
Head injury signs
Scalp hematoma
Vomiting
Neck and airway concerns
Voice change
Stridor
Chest and abdominal exam
Tenderness
Guarding
Skin exam
Wounds needing care
Infection signs
Differential Diagnosis
Primary psychiatric syndromes
Psychiatric differentials
Major depressive disorder with suicidal ideation
ICD 10 F32.9
SNOMED CT depressive disorder
Bipolar disorder
Mixed features risk
ICD 10 F31.9
Schizophrenia spectrum and other psychotic disorder
Command hallucinations
ICD 10 F20.9
PTSD
Reexperiencing and hyperarousal
ICD 10 F43.10
Borderline personality disorder traits
Affective instability
ICD 10 F60.3
Substance and medication related
Substance and medication differentials
Alcohol intoxication
Acute disinhibition
ICD 10 F10.129
Substance induced mood disorder
Temporal relation to use
ICD 10 F19.94
Withdrawal states
Alcohol withdrawal
ICD 10 F10.239
Medication adverse effects
Akathisia
Steroid induced mood change
Medical and neurologic mimics
Medical differentials
Delirium
Fluctuating attention
SNOMED CT delirium
Hypoglycemia
Altered mental status
ICD 10 E16.2
Thyroid disease
Hyperthyroidism anxiety
ICD 10 E05.90
CNS infection or inflammation
Fever with confusion
Meningitis encephalitis consideration
Traumatic brain injury
Recent head trauma
ICD 10 S06.9X0A
Coding and clinical terminology
Coding considerations
Suicidal ideation
ICD 10 R45.851
SNOMED CT suicidal thoughts
Suicide attempt
ICD 10 T14.91
SNOMED CT suicide attempt
Personal history of self harm
ICD 10 Z91.5
SNOMED CT history of self harm
Laboratory Tests
Core medical clearance set
Baseline labs for medical contributors
Point of care glucose
Hypoglycemia threshold based on local lab reference
Repeat after treatment if low
Electrolytes and renal function
Sodium mmol per L for confusion
Creatinine for renal impairment
Liver enzymes
Hepatic injury from ingestion
Chronic liver disease baseline
Complete blood count
Infection concern
Anemia concern
Overdose and ingestion evaluation
Toxicology oriented labs
Acetaminophen level
Draw at 4 hours after ingestion if timing known
Repeat if extended release concern
Salicylate level
Repeat levels for rising concentration concern
Acid base monitoring needs
Ethanol level
Intoxication contribution
Withdrawal risk stratification
Urine drug screen
Limited diagnostic specificity
Confirmatory testing needs for medico legal decisions
Creatine kinase
Rhabdomyolysis risk with agitation or immobility
Renal protection planning
Pregnancy and sexual health considerations
Reproductive health tests
Pregnancy test
All patients with pregnancy potential
Imaging and medication planning
STI testing when indicated
Assault concern
High risk exposure
Additional tests by presentation
Targeted labs
Thyroid stimulating hormone
New mood or anxiety symptoms
Thyrotoxicosis concern
Venous blood gas
Acid base concern
pH and pCO2 in mmHg
Lactate
Sepsis concern
Shock physiology
Coagulation studies
Anticoagulant exposure
Bleeding concern
Diagnostic Tests
Scoring Systems
Risk stratification tools
Columbia Suicide Severity Rating Scale
Ideation severity
Behavior assessment
SAFE T framework
Risk factors
Protective factors
ASQ for youth screening
Brief screening in pediatric settings
Positive screen workflow
Limitations
Tools do not replace clinical judgment
Risk can change rapidly
MRI
MRI indications in this context
Neurologic red flags
New focal deficit
Concern for mass lesion
Advantages
No ionizing radiation
Better soft tissue detail
Limitations
Time and availability
Motion artifact in agitation
CT
CT indications in this context
Head CT
Head trauma concern
Altered mental status unexplained
Neck and chest imaging
Airway injury concern
Respiratory distress
Advantages
Rapid acquisition
Broad availability
Limitations
Radiation exposure
Incidental findings
Ultrasound (or US)
Ultrasound applications
Point of care ultrasound
Volume status assessment in shock
Lung ultrasound for respiratory failure
Soft tissue ultrasound
Abscess evaluation if wound infection
Foreign body concern
Advantages
Bedside assessment
No radiation
Limitations
Operator dependent
Limited in obesity or gas
Disposition
Level of care decisions
Disposition risk tiers
High risk criteria
Active intent with plan
Recent suicide attempt
Moderate risk criteria
Suicidal ideation without intent
Limited protective factors
Lower risk criteria
Passive thoughts only
Strong protective factors and supports
Documentation elements
Rationale for disposition
Means restriction plan
Admission and transfer
Hospitalization indications
Inpatient psychiatric admission
Persistent intent
Inability to maintain safety
Medical admission
Toxic ingestion requiring monitoring
Medical instability
Transfer criteria
Need for pediatric psychiatry
Need for ICU monitoring
Discharge readiness
Discharge prerequisites
No current intent
Stable mental state
Reliable safety plan
Safe environment
Responsible adult support for minors
Removal or secure storage of lethal means
Follow up within short interval
Mental health appointment scheduled
Primary care notified when appropriate
Return precautions
Worsening thoughts
New plan or intent
Treatment
Safety planning and brief interventions
Evidence based brief interventions
Safety plan components
Warning signs list
Personal triggers
Early symptoms
Internal coping strategies
Grounding techniques
Distraction activities
Social supports
People to contact
Safe places
Professional resources
Crisis line options
Urgent clinic access
Means restriction
Secure medications
Secure firearms
Caring contacts
Follow up message plan
Appointment reminders
Pharmacotherapy for associated syndromes
Medication approach principles
Treat underlying psychiatric syndrome when indicated
Depression management pathway
Psychosis management pathway
Avoid new sedatives solely to suppress ideation
Focus on safety and definitive care
Monitor for disinhibition risks
Medication reconciliation
Recent dose changes
Adherence barriers
Agitation management
Acute agitation treatment
Non pharmacologic first line
De escalation
Sensory reduction
Medication options per local protocol
Antipsychotic for psychosis driven agitation
ECG for QT prolongation risk when feasible
Monitor for dystonia and akathisia
Benzodiazepine for stimulant intoxication
Respiratory depression monitoring
Avoid in severe alcohol intoxication when unsafe
Restraint monitoring bundle
Frequent reassessment
Circulation and skin checks
Toxicology treatment pathways
Ingestion management
Acetaminophen toxicity
N acetylcysteine initiation per nomogram criteria
IV protocol per local guideline
Repeat acetaminophen and transaminases
Salicylate toxicity
Alkalinization strategy per toxicology
Sodium bicarbonate infusion protocol per local guideline
Target urine alkalinization monitoring
Opioid toxicity
Naloxone titration to adequate ventilation
Repeat dosing based on recurrence
Observe for renarcotization
Serotonin toxicity
Discontinue serotonergic agents
Benzodiazepines for agitation
Intensive monitoring for hyperthermia
Evidence and guideline framing
Recommendation strength framework
Suicide risk screening in ED
ACEP Level B support for structured screening in appropriate populations
ACEP Level C for tool selection based on local workflow
Lethal means counseling
Class I recommendation by expert consensus for safety planning elements
Class IIa for caring contacts follow up strategies
Special Populations
Pregnancy
Pregnancy specific considerations
Maternal fetal safety priorities
Obstetric consult triggers
Fetal viability considerations by gestational age
Medication safety
Avoid teratogenic agents when possible
Shared decision making for acute agitation meds
Imaging approach
Prefer ultrasound when appropriate
CT only when benefits outweigh risks
Geriatric
Older adult considerations
High lethality attempt risk
Social isolation
Medical comorbidity burden
Medication sensitivity
Lower starting doses for sedatives
Delirium risk
Cognitive assessment needs
Dementia screening when indicated
Capacity concerns
Pediatrics
Youth and adolescent considerations
Developmental context
Impulsivity and peer influence
Bullying and online harassment screening
Family involvement
Guardian notification expectations
Family safety planning role
School and community coordination
School counselor liaison when appropriate
Community mental health referrals
Background
Epidemiology
Epidemiology overview
Suicide as leading cause of death in adolescents and young adults
Variation by region and demographics
Higher risk with prior attempt
Prior attempt as strongest predictor of future attempt
Elevated risk shortly after ED visit
Need for rapid follow up
Common comorbidities
Depression
Substance use disorder
Pathophysiology
Biopsychosocial model
Neurobiology contributors
Serotonergic dysfunction hypotheses
Stress response dysregulation
Psychological contributors
Cognitive constriction
Hopelessness
Social contributors
Trauma exposure
Social isolation
Therapeutic Considerations
Treatment rationale
Safety planning as immediate harm reduction
Skills for crisis moments
Environmental risk reduction
Addressing underlying drivers
Treat mood and psychotic disorders
Treat substance use disorders
Continuity of care
Rapid outpatient follow up improves engagement
Post discharge contacts reduce repeat attempts
Patient Discharge Instructions
copy discharge instructions
Discharge instruction text
Safety plan copy provided
Warning signs list
Coping steps list
Crisis supports
Local crisis line number provided
Emergency services for imminent danger
Means safety at home
Medications locked and counted
Sharps secured
Follow up plan
Appointment date and location
Transportation plan
Return to ED now for
Suicidal thoughts getting worse
New plan or intent
Feeling unable to stay safe
References
Clinical guidelines and consensus
Guideline sources
American Psychiatric Association practice guideline for the assessment and treatment of patients with suicidal behaviors
Risk assessment principles
Safety planning emphasis
Joint Commission National Patient Safety Goal on suicide prevention
Screening and risk assessment expectations
Environmental safety in healthcare settings
SAMHSA SAFE T framework
Structured risk assessment approach
Disposition guidance
American Academy of Pediatrics guidance on youth suicide prevention
Screening tools for adolescents
Family centered safety planning
Evidence based tools and studies
Evidence sources
Columbia Suicide Severity Rating Scale validation literature
Predictive validity for attempts
Standardized severity language
ED Safety Planning Intervention trials
Reduced suicidal behavior with safety planning plus follow up contacts
Improved outpatient engagement
Lethal means counseling evidence
Reduced access associated with reduced suicide deaths
Counseling improves safe storage behaviors
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.