Confused Andor Violent Behavior

Not only psychological, but also physical conditions, illnesses, and injuries are common causes of behavioral emergencies. The following examples can produce changes in the cerebral chemistry or tissue, disrupting the cerebral metabolism and oxygenation which consequently leads to neurological dysfunction.

a. Medical illness.

(1) Organic brain syndrome (disruption of and impairment of function of brain tissue from variety of causes).

(2) Severe infection.

(3) Cerebral or pulmonary emboli.

(4) Electrolyte disorders.

b. Head trauma.

c. Hypoxia.

d. Personality disorders (for example, poor impulse control).

e. True neuropsychiatric illness.

(1) Paranoia. Paranoia is a form of psychosis characterized by delusions (of grandeur, of persecution, and so forth).

(2) Schizophrenia. Schizophrenia is a psychosis characterized by delusions and hallucinations marked withdrawal from interpersonal relations, severe deterioration of personal habits, and bizarreness of gestures and speech.

f. Senile dementia in elderly.

g. Suicidal crisis.

h. Substance abuse.

(1) Drugs (intoxication and withdrawal syndromes).

(2) Alcohol (acute intoxication and alcohol withdrawal syndrome). i. Severe situational stress/anxiety. 5-4. ACUTE ALCOHOL INTOXICATION

a. Alcohol normally acts as a depressant. It dulls reflexes, dulls sense of awareness, decreases reaction time, and depresses one's inhibitions (therefore, sometimes thought of as stimulant).

NOTE: The acutely alcohol intoxicated patient may exhibit signs like patients with physical injuries or illnesses. Also, alcohol intoxication may mask signs and symptoms of underlying physical or psychological illness.

b. Acute disorientation can occur with varying levels of alcohol intake in an inexperienced drinker (young, elderly, and so forth). Normally, the average adult would have to drink enough to become sedated before becoming disoriented. Disorientation often occurs when alcohol is mixed with other drugs.

c. A drunken patient may show extreme behavior. He may exhibit aggression, destructiveness, belligerence, combativeness, paranoia, and/or inappropriate behavior.

d. Gross behavioral disturbance is often a sign of an underlying or additional problem besides ingestion of alcohol (for example, psychiatric illness, ingestion of hallucinogenics or stimulants).

e. Alcohol withdrawal syndromes occur in a person who is used to constant alcohol intake. When the supply is withdrawn, the patient may manifest alcohol hallucinations and/or delirium tremens.

f. Management of acutely alcohol intoxicated patient.

(1) Protect the patient from harming himself and/or others.

(2) Maintain the patient's airway and prevent him from aspiration.

(3) Monitor the patient's vital signs.

(4) Evaluate the patient for underlying illness and/or injury.

(5) Administer oxygen to the patient and start an IV with normal saline.

(6) Prepare to have the patient evacuated to the nearest medical treatment facility (MTF).

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