Page 196 - ATP-P 11th Ed

BEHAVIORAL CHANGES PROTOCOL
(INCLUDES PSYCHOSIS, DEPRESSION, SUICIDAL IMPULSES)

SPECIAL CONSIDERATIONS
1. In a tactical setting consider sleep deprivation as a cause.
2. Etiologies are numerous and will often dictate the management; thus mental
status changes could be caused by head trauma, metabolic and endocrine disease
SECTION 2 processes, environmental toxins, infections, combat stress disorder, hypo xia, hy-
perthermia, hypothermia, pharmaceutical agent use (e.g., mefloquine [Lariam ])
®
or withdrawal.
3. Consider diabetic hypoglycemia as a cause of altered mental status.

Signs and Symptoms
1. Acute behavioral changes include withdrawal, depression, aggression, confusion, or
other behavioral patterns atypical for the individual.
2. Psychosis is an acute change in mental status characterized by altered sensory percep-
tions that are not congruent with reality:
a. Auditory and/or visual hallucinations
b. May include violent or paranoid behavior
c. Disorganized speech patterns are common
d. May include severe withdrawal from associates
Management
1. Remove all weapons or potential weapons from patient AND treating Medic.
2. Check pulse oximetry.
3. Place patient in safe environment under continuous surveillance.
4. Place either 1 tube of oral glucose gel containing 40% dextrose (d-glucose), (Glutose45 )
™
or contents of one packet of sugar in the buccal mucosal region for possible hypoglycemia.
5. Take Temperature
a. If temperature is below 95° F (35° C), treat per Cold Injury Protocol.
b. If temperature is above 101° F (38.3° C), treat per Meningitis Protocol.
c. If temperature is above 103° F (39.4° C), treat per Meningitis & Heat Illness
Protocols.

186 SECTION 2 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) ATP-P Handbook 11th Edition 187