PSYCHIATRIC EMERGENCIES

Published on 14/03/2015 by admin

Filed under Emergency Medicine

Last modified 14/03/2015

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PSYCHIATRIC EMERGENCIES

The wilderness experience can be quite stressful, and a member of the party may behave in an unusual fashion. This may be directly related to the events at hand or reflect an underlying psychiatric disorder. It is imperative that someone recognize warning signs early and evacuate anyone who cannot retain mental stability, to avoid placing the impaired individual and his traveling companions at risk for injury.

ANXIETY

Anxiety is the most common psychiatric symptom, and may range from appropriate and adaptive minor doubts about success to a full-blown panic reaction. Minor anxiety is expressed as general discomfort about a situation. The excessive worrier may become timid and withdrawn, and may lose his enthusiasm for participation. His anxiety may be clothed in criticism of plans or refusal to cooperate. It is important that every member of the expedition voice fears and objections at the outset, so as not to be caught in a panic when crossing treacherous terrain or performing rescues.

The treatment is reassurance and support. Frequently, practice sessions that build up to a completed effort will relieve anxiety and improve the performance of the group. In no case should anyone be made to feel ashamed of his fears. Rather, the leader should seek to help the victim conquer them.

Approach what problems you can directly. Most people do much better if fear is identified and managed than if it is never confronted.

In certain circumstances, where anxiety must be conquered to allow extrication, rescue, or even survival, judicious use of an antianxiety drug, such as lorazepam (Ativan) 0.2 to 2 mg, alprazolam (Xanax) 0.5 mg, or diazepam (Valium) 2 to 5 mg may be useful.

PANIC

Panic is anxiety in the extreme. Signs and symptoms may include heart palpitations, sensation of pounding heart, rapid heart rate, sweating, trembling or shaking, shortness of breath or a sensation of “smothering,” choking sensation, chest discomfort, nausea, dizziness, fainting, a sensation of loss of reality, and fear of dying. The victim loses all judgment and becomes consumed with efforts at escape and self-preservation. Panic renders the victim unable to make reasonable decisions and immediately places him and all around him at risk for injury. The rescuer must assume a strong authoritative posture with the panic victim, assuring him in no uncertain terms that the situation is under control and the panic behavior is detrimental. Depending on the situation, this can be done with verbal explanations, convincing arguments, or demonstrations of safety. As for anxiety, antianxiety drugs such as diazepam, lorazepam, or alprazolam may be helpful. If the victim places other individuals at immediate risk for injury, he should be subdued, with force if necessary.

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