Psychiatry in the ED

A 23 y/o F patient presents to the ED with chest pain and SOA. What is your first step in caring for this patient?

• Anything serious is unlikely at this age, send her home w/psych resources

• Administer one dose of a benzodiazepine

• Consult Cardiology immediately

• Complete history and physical. Order labs, EKG, etc. based on symptoms.

A farmer presents w/numerous symptoms after spraying his garden w/pesticides. Which is NOT a treatment for his symptoms?

• Atropine

• Pralidoxime

• Benzodiazepines

• Physostigmine

What is seen on EKG with TCA overdose?

• Bradycardia

• ST elevation

• Widening of the QRS

With which sympathomimetic must you restrict fluids or use hypertonic saline?

• Amphetamines

• MDMA (ecstasy)

• Cocaine

• Ephedrine

How do you differentiate the sedative-hypnotic toxidrome from the opioid toxidrome?

• HR/BP/RR/Temperature

• Diaphoresis vs. dry skin

• Pupils

• Bowel sounds

What is seen in the sympathomimetic toxidrome that differentiates it from the anticholinergic toxidrome?

• Decreased respirations, diaphoresis

• Decreased respirations, dry skin

• Increased respirations, diaphoresis

• Increased respirations, dry skin

A 53 y/o M comes in to the ED weekly with SOA. Work-up is always unremarkable. What do you do when he presents to the ED again with similar symptoms and you are assigned to care for him?

• Consult psychiatry

• Complete a H&P. Order labs, EKG, etc. as appropriate.

• Reassure this is another panic attack. Discharge with psych f/u.

• Give patient a benzodiazepine and discharge.

A 21 y/o F presents with dizziness and chest pain. Exam, vitals, troponin, and EKG WNL. Urine hCG is positive. What do you do next?

• This is a panic attack. Give lorazepam and discharge with OB f/u.

• Monitor for symptom improvement and provide reassurance. Recommend OB f/u.

You diagnose a panic attack in the ED. What do you do next?

• Give a benzo if appropriate, provide resources, send home w/follow-up

• Consult psychiatry

• Send home with a prescription for benzos

• Admit to the inpatient unit

What toxidrome causes pinpoint pupils?

• Anticholinergic

• Sympathomimetic

• Opioid

• Sedative-hypnotic