Page 95 - PJ MED OPS Handbook 8th Ed

Behavioral Changes (Psychosis, Depression, and 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 processes,
environmental toxins, infections, combat stress disorder, hypoxia, hyperthermia, hypo-
thermia, pharmaceutical agent use (e.g., mefloquine) 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 be-
havioral patterns atypical for the individual.
2. Psychosis is an acute change in mental status characterized by altered sensory perceptions 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, glucose level, temperature, pupils for constriction.
3. Place patient in safe environment under continuous surveillance.
4. Place either 1 tube of Glutose (oral glucose gel) or contents of one packet of sugar in the buccal
mucosal region for possible hypoglycemia if unable to confirm via glucometer.
5. Take temperature:
a. If Temperature is below 95°F, treat per Hypothermia Protocol
b. If Temperature is above 101°F, treat per Meningitis Protocol
c. If Temperature is above 103°F, treat per Meningitis and Hyperthermia Protocols

NOTE: IF MENINGITIS IS SUSPECTED OR IF THERE IS A DECREASE IN MENTAL STATUS, USE
VERSED WITH CAUTION, DUE TO POSSIBLE RESPIRATORY DEPRESSION, HYPOTENSION,
AND MASKING OF PROGRESSION OF DISEASE-RELATED ALTERED MENTAL STATUS.

6. For acute agitation, combativeness, or violent behavior, restrain patient with at least four indi-
viduals and give midazolam (Versed) 5mg IM and repeat q15–30min PRN; if using IV/IO, use 2mg
increments.

NOTE: If sedated or restrained, maintain constant vigilance for a change in the hemodynamic
status or loss of airway reflexes or respirations.

DISPOSITION:
1. Urgent evacuation.

Chapter 8. Tactical Medical Emergency Protocols (TMEPs) n 93