Do you document the following on all suicidal/depressed patients you discharge home?

• marriage status
  
• race
  
• employment status
  
• any cohabitants
  

If not, consider doing so.

Risk factors for eventual suicide include widowed or divorced, white or Native American race, unemployed and living alone. Other risk factors, which are generally covered in charts more habitually - and without much thought -include age older than 60, male sex, recent adverse event, psychiatric illness (depression, schizophrenia, panic disorder), substance abuse and history of suicide attempts or ideation.


Source

Raviprakash-Sood, T and Mcstay, C. "Evaluation of the Psychiatric Patient" Emerg Med Clin N Am. 2009.

In assessing the need for admission of a potentially violent patient, what is the most reliable predictor of future violent behavior?

History of violent behavior.

No studies to date have been able to provide great epidemiologic clues to identify patients that are likely to commit homicide after discharge from the ED. Patients age, gender, socioeconomic status, etc have consistently failed to predict the risk of violence.


Source

Raviprakash-Sood, T and Mcstay, C, "Evaluation of the Psychiatric Patient" Emerg Med Clin N Am. 2009

Hiccup ... Hiccup ..... Hiccup ... What's the ED evaluation and treatment of this condition?

Generally benign but if last > 48 hours a more thorough evaluation for the underlying etiology should be pursued. Causes include:

Central Nervous System

• infection


• structural lesions

Metabolic

• alcohol


• uremia


• diabetes mellitus


• hyponatremia


• hypocalcemia

Drugs

• general anesthesia


• dexamethasone


• diazepam

Vagus and phrenic nerve irritation

• foreign body against tympanic membrane irritates auricular branch of vagus nerve


• any mass or infection along pathway of vagus or phrenic from neck down to diaphram

Psychogenic

Idiopathic

• click here to see video of unfortunate man with intractable idiopathic hiccups

Pursue appropriate testing based on history and physical. For symptomatic relief consider chlorpromazine or metoclopramide while searching for underlying cause.

Source

Fishman, Mary MD. "Overview of hiccups." Up to Date. 4 September 2008.