- ABCs as always
- Vital Signs (PR, BP, RR, Temp, SpO2, Glucose) - Do not ignore abnormal VS
- Pupils and Skin exam (pick cues for toxidromes)
- Focused History (Next of Kin/Paramedics) and Physical exam
- Focus on underlying Psych issues (Drugs/Alcohol, Sexual, Suicidal, Homicidal, Social aspects)
- Medications and Co-Morbidities
- Document Mental Exam - Appearance, Behaviour, Cognition, Speech, Mood, Insight, Thoughts, Hallucinations
1. New-onset psychiatric complaints
2. Abnormal vital signs
4. Known co-morbid conditions.
Even Urine Drug Sceen is not required routinely for all. Most of them will tell you what drugs they have recently taken. Also remember, UDS may have false positive and negatives which can be misleading.
Signs suggesting underlying medical pathology are:
- Abnormal Vital Signs
- Clouded Consciousness
- Age >40 with no previous Psych issues
- Focal deficits on exam
- Abnormal Physical examination
- Visual Hallucinations
- Spend more time on history and exam rather than doing bloods on everyone
- Do not ignore abnormal Vital Signs
- Look at issues that often co-exist with Psych illnesses - Drugs/Alcohol, Sexual, Suicidal, Homicidal, Social aspects
- Korn CS, Currier GW, Henderson SO: Medical clearance of psychiatric patients without medical complaints in the emergency department. J Emerg Med 18: 173, 2000.
- American Psychiatric Association: Practice guideline for psychiatric evaluation of adults. Am J Psychiatry 152: 63, 1995.
- Korn CS, Currier GW, Henderson SO: “Medical clearance” of psychiatric patients with- out medical complaints in the emergency department. J Emerg Med 18: 173, 2000.
- Olshaker JS, Browne B, Jerrard DA, Prendergast H, Stair TO: Medical clearance and screening of psychiatric patients in the emergency department. Acad Emerg Med 4: 124, 1997.
- Broderick KB, Lerner B, Mccourt JD, Fraser E, Salerno K: Emergency physician practices and requirements regarding the medical screening examination of psychiatric patients. Acad Emerg Med 9: 88, 2002.