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    Psychiatric Patient (beta)

    Official guideline from the American College of Emergency Physicians.

    Summary by Eric Steinberg, DO
    Strength
    Level A
    Level B
    Level C

    Recommendations

    Risk Stratification
    1. In patients presenting to the emergency department with suicidal ideation, physicians should not use currently available risk-assessment tools in isolation to identify low-risk patients who are safe for discharge. The best approach to determine risk is an appropriate psychiatric assessment and good clinical judgment, taking patient, family, and community factors into account.
    Laboratory Testing
    1. Do not routinely order laboratory testing on patients with acute psychiatric symptoms. Use medical history, previous psychiatric diagnoses, and physician examination to guide testing.
    Brain Imaging
    1. Use individual assessment of risk factors to guide brain imaging in the emergency department for patients with new-onset psychosis without focal neurologic deficit. [Consensus recommendation]
    Ketamine for Agitation
    1. Ketamine is one option for immediate sedation of the severely agitated patient who may be violent or aggressive. [Consensus recommendation]
    What do the icons mean?  
    Research PaperNazarian DJ, Broder JS, Thiessen MEW, et al. American College of Emergency Physicians. Clinical Policy: Critical Issues in the Diagnosis and Management of the Adult Psychiatric Patient in the Emergency Department. Ann Emerg Med. 2017;69(4):480-498.