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Biomedical subjects

E E Kercher

Publications and source records attributed to E E Kercher.

6 recordsLinked to original sources
PubMed1991

Acute psychosis. Functional versus organic.

Acute psychosis is a true emergency and is a manifestation of multiple organic and functional disorders. The emergency medicine physician's role in dealing with the acutely psychotic patient is to control the patient's behavior, to delineate the etiology of the psychosis, and to provide appropriate initial treatment and disposition. When making initial contact with the psychotic patient, behavioral control can be accomplished through supportive, physical, or pharmacologic interventions. Judicious use of rapid tranquilization permits rapid control of these patients when supportive and other nonpharmacologic therapies fail. Initial examination is directed at identifying immediate life-threatening organic disorders and promptly treating them. Historical data, mental status examination, physical examination, and appropriate radiologic and laboratory investigations give information that assist in delineating functional from organic psychosis. Most acute organic psychoses, with the exception of some drug intoxications that clear in the Emergency Department, require medical or surgical admission. Acute functional psychotic patients who are a danger to themselves or others, who are without a reliable social support system, or who present with their first psychotic episode require admission to the psychiatric service for further evaluation and treatment.

Acute Disease↗
PubMed1991

Anxiety.

The general principles useful in approaching most psychiatric emergencies are equally applicable to the handling of the anxious patient. Establish rapid contact because anxious patients should not be left waiting. Expedite talking to reduce tension because putting thoughts and emotions into words invariably reduces initial tension. Make a quick first assessment of the anxious patient's general appearance, level of consciousness, level of tension, and leading affect or mood. Choose a private and relaxed setting for the interview if possible. Allow for a slow final evaluation because many initially overwhelmed anxious people may reconstitute within a matter of hours when allowed to talk, rest, or even sleep. Take the anxious patient's chief complaint seriously. A brief physical examination should be performed routinely in almost all cases, especially when there is a physical complaint. Every attempt should be made to rule out an organic etiology for the anxiety. Listening is an active but demanding process. Most of the time it means sitting down and giving all of one's attention to the patient, even if it is for just a few minutes. What patients find most comforting is the feeling of being understood. The emergency medicine physician should be careful to avoid a judgmental or punitive approach. Every attempt should be made to engage the family in caring for the patient while in the Emergency Department. It is equally important to recognize that relatives and friends may need assistance to help cope with the anxious patient once discharged. The emergency medicine physician needs to assess the degree of social support available in the patient's environment because a sensible disposition will depend on it.

Anxiety↗
PubMed1991

Crisis intervention in the emergency department.

The word crisis implies a challenge to the personality, family, and community created by an altered set of circumstances for which adaptive resources are not readily available. It has long been recognized that mastery of a crisis can result in an enrichment of the personality, which then acquires resources to deal with similar events in the future. Failure to meet the challenge results not infrequently in a maladaptive response, which, too, is likely to be applied to similar challenges in the future--thereby burdening the personality with a handicap. Intervention in crisis aims at assisting the individual toward meeting his or her crisis successfully, and at times entails little more than guidance, advice, or education. When analyzed more adequately, intervention implies an evaluation of the resources within the individual, an evaluation of the resources among those who surround the individual in the family and the community, and an assessment of his or her past personal history. This takes into account how the individual has handled previous crises in his life; educational, vocational, marital, and social achievements; preferences; values; and what he or she expects from professional help. The individual is then invited, with those around him and involved with him, to examine the strengths that are available to him and to participate where possible in planning the steps immediately necessary for the successful resolution of the crisis.

Communication↗