how deep insight in psych. and neuro.?

[rayoflite]

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I was just wondering about how much diagnostic/therapeutic power ER doctors have when evaluating psych and neuro pts. Do you always need to call a consultant?
I know it depends on the situation but I'd like to know how deep and far diagnosticaly and therapeuticaly one can go in the ER...

 

[rayoflite]

alright, I have read through some more posts that gave me an idea about ER neuro...still don't have a picture about psych in ER.

 

[NinerNiner999]

Basically, unless someone is presenting with suicidial thoughts, homicidal thoughts, acute mania, or drug overdose, they can go home (of course this is a VERY general statement and there are many dispositional exceptions). Those who need medication for agitation or other problems can get emergency papered (Committed) and see the psych liason...

 

[rayoflite]

Basically, unless someone is presenting with suicidial thoughts, homicidal thoughts, acute mania, or drug overdose, they can go home (of course this is a VERY general statement and there are many dispositional exceptions). Those who need medication for agitation or other problems can get emergency papered (Committed) and see the psych liason...

...so ,either home or temporary admission and if the later then always call a psychiatrist, right? it's not like with everything else = "... treat what you feel comfortable dealing with ..." - is that how it works?
thanks

 

[totalbodypain]

...so ,either home or temporary admission and if the later then always call a psychiatrist, right? it's not like with everything else = "... treat what you feel comfortable dealing with ..." - is that how it works?
thanks

I would argue that almost every patient I see on a daily basis in the county setting has some sort of underlying psychopathology that you have to weed through to just get your job done. Because of that when the normally worried well come in most EPs (at least at my institution) are way to busy, tired or generally uninterested to do anything other than refer to the psych clinic or call a psych consult for HI, SI etc. Is this the best that we could do? Probably not. But when you see more than 150,000 pts a year at an institution the worried well are often the least of your worries.

 

[rayoflite]

Is this the best that we could do? Probably not. But when you see more than 150,000 pts a year at an institution the worried well are often the least of your worries.

Understandably so, although I was trying to figure out ER treatment/managment of true psych pts (exacerb. melanch. depression, schiz., drug induced psychosis) in terms of - do you medicate or do you wait for a psychiatrist?
thanks for the input and I would love to learn more...

 

[docB]

We sedate so the person stops being a danger to themselves and others. I leave the long term medication (mood stabilizers, SSRIs, etc.) to the psychaitrists, or in my town the psych nurses. As Niner mentioned correctly we don't do much with people who do not present an immediate danger to themselves or others. If someone comes to the ER with depression but no SI and wants Prozac they will get referred.

 

[roja]

Ditto what all is being said here. Knowing your limits is crucial in the ED. Delving deeply into psychoanlysis is definately (and thankfully) not in teh scope of the ED. Keeping people from harming themselves and treating any medical issues is the job and then allowing your psych to deal with it is the norm where I am. No starting of long term medications.

It is important to recognize patients that need a referral to be put into the appropriate refererrals (sometimes depression doesn't manifest as depression but random and odd visits to the ed)