emDocs - November 25, 2016 - Author: Simon E - Edited by: Koyfman A
"Key Pearls
- Stabilize as appropriate => a number of patients will present after performing self-harm
- If the patient is hemodynamically unstable, consider an EKG to evaluate for sodium channel blockade (TCA overdose)
- Quickly evaluate for signs/symptoms of toxic ingestions
- In the stable patient, perform an H&P focusing on risk factors for suicide
- Question patients regarding substance abuse (specifically alcohol)
- Question regarding access to weapons
- Use friends/family to corroborate stories
- During the physical examination, evaluate for findings consistent with toxidromes or organic pathology
- After seeking out organic etiologies of suicidal ideation, medically clear the patient and consult a specialist
- Be familiar with state laws regarding emergency detention
- Avoid the use of safety contracts in the emergency setting"