Emergency Psychiatry
Started by rgerwin
You will ALWAYS have a job!
It doesn't really exist anywhere else...
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What about it?
I'm a fan of open-ended questions, unless, of course, I'm the one answering them. But seriously, what would you like to know?
I'm sure it does exist in a non-urban setting, just that most as far as I'm aware are in urban settings.
In most states you only have a limited time (usually up to 24 hrs, though some states I believe its up to 3 days) to hold them if you think the person may be dangerous. This requires a diagnosis which may not be correct.
In addition to what people may imagine what would happen, here's lots of real life things that happen that you may not have imagined...
You'll get several people claiming to be suicidal who really only want 3 hots and a cot. You'll get others who don't need to be there, but were turf jobs from others.
e.g. if the ER gets a homeless person they don't want to deal with, several ER doctors will say the person said they were suicidal (which the patient never said) so they become psychiatry's problem. then you got to spend an extra hour to few hours establishing that the person was not suicidal. The local school may give you someone because that person saw GI Joe the movie, and kept talking about this dark ninja that kills bad guys and carries a gun--oh no! He may be the next Columbine killer, so now you got to evaluate the kid.
You may also get people who are not medically cleared in your opinion, but the ER doctor has medically cleared them. E.g. a person who's BP is 230/130, and the ER doctor won't touch them. I had this situation occur about once a week when I worked in ER psychiatry, and I'd say (and of course I'm biased) about 95% of the time I tried to get them back to the ER doctor I was right and the ER doctor was wrong. The only time I tried to turf the patient back to another doctor where the department heads were upset with me was a situation where the patient was unconcious for 24 hrs straight and her arm started to turn blue. Attempts to arouse her were unsuccesful though her labs were normal. In light of her arm turning blue (witnessed by 3 people who documented it, and I saw it myself). I demanded she be sent to the medical floor--and this was after about 10 hrs of debating this with people in other departments. Finally after 10 hrs of this, an IM doctor came over to the psychiatry unit, checked her out and okayed the transfer, and even he noted the cyanotic appearing arm.
Within 10 minutes of having an IV put into her she awoke and showed no problems. WTF happened in that situation I still don't know. Her arm showed no problems after she woke up, and she was her borderline self and upsetting the medical floor staff. If that situation arose again I still would've done what I did, but the medical staff were very upset because I was manage to turf one on them, and hyped it up more than it should have been.
In most states you only have a limited time (usually up to 24 hrs, though some states I believe its up to 3 days) to hold them if you think the person may be dangerous. This requires a diagnosis which may not be correct.
In addition to what people may imagine what would happen, here's lots of real life things that happen that you may not have imagined...
You'll get several people claiming to be suicidal who really only want 3 hots and a cot. You'll get others who don't need to be there, but were turf jobs from others.
e.g. if the ER gets a homeless person they don't want to deal with, several ER doctors will say the person said they were suicidal (which the patient never said) so they become psychiatry's problem. then you got to spend an extra hour to few hours establishing that the person was not suicidal. The local school may give you someone because that person saw GI Joe the movie, and kept talking about this dark ninja that kills bad guys and carries a gun--oh no! He may be the next Columbine killer, so now you got to evaluate the kid.
You may also get people who are not medically cleared in your opinion, but the ER doctor has medically cleared them. E.g. a person who's BP is 230/130, and the ER doctor won't touch them. I had this situation occur about once a week when I worked in ER psychiatry, and I'd say (and of course I'm biased) about 95% of the time I tried to get them back to the ER doctor I was right and the ER doctor was wrong. The only time I tried to turf the patient back to another doctor where the department heads were upset with me was a situation where the patient was unconcious for 24 hrs straight and her arm started to turn blue. Attempts to arouse her were unsuccesful though her labs were normal. In light of her arm turning blue (witnessed by 3 people who documented it, and I saw it myself). I demanded she be sent to the medical floor--and this was after about 10 hrs of debating this with people in other departments. Finally after 10 hrs of this, an IM doctor came over to the psychiatry unit, checked her out and okayed the transfer, and even he noted the cyanotic appearing arm.
Within 10 minutes of having an IV put into her she awoke and showed no problems. WTF happened in that situation I still don't know. Her arm showed no problems after she woke up, and she was her borderline self and upsetting the medical floor staff. If that situation arose again I still would've done what I did, but the medical staff were very upset because I was manage to turf one on them, and hyped it up more than it should have been.
