Page 109 - 2022 Ranger Medic Handbook

Behavioral Emergency Management
(Includes Psychosis, Depression, Suicidal Impulses)
Behavioral Conditions
In a tactical setting, consider sleep deprivation as a cause. Etiologies are numerous and will often dictate the manage-
ment; thus, mental status changes could be caused by head trauma, metabolic and endocrine disease processes,
environmental toxins, infections, combat stress disorder, hypoxia, hyperthermia, hypothermia, pharmaceutical agent use
(i.e., mefloquine), or withdrawal. Consider diabetic hypoglycemia as a cause of altered mental status.
S/Sx: Acute behavioral changes include withdrawal, depression, aggression, confusion, or other behavioral patterns
atypical for the individual.
Psychosis is an acute change in mental status characterized by altered sensory perceptions that are not congruent with
reality: auditory and/or visual hallucinations; may include violent or paranoid behavior; disorganized speech patterns are
common; may include severe withdrawal from associates. SECTION 3
Initial Management & Extended 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. Give contents of 1 sugar packet sublingually to treat for possible hypoglycemia.
5. Take core temperature. If temperature is below 95°F, treat per Hypothermia Protocol. If temperature is above 101°F,
treat per Meningitis Protocol. If temperature is above 103°F, treat per Meningitis and Hyperthermia Protocols
6. For acute agitation, combativeness, or violent behavior, restrain patient with at least four individuals and give mid-
azolam 5mg IM OR diazepam 10mg IM. Repeat after 30 minutes prn.
7. If sedated or restrained, maintain constant vigilance for a change in the hemodynamic status or loss of airway reflexes.
8. Evacuate urgent as tactically feasible.

AMSIT Patient History Neurological Assessment
Appearance, Behavior, & Speech (ill or Mental Status Motor Status
distressed, posture & body language, willingness • Orientation • Posture
to talk, manner, evidence of emotions, attention • Affect • Strength in basic
span, speech patterns) • Speech (content & process) muscle movements
Mood & Affect (anger, fear, anxiety, elation, • Resistance to
intensity and changes in mood) Cranial Nerves passive movement
Sensorium (oriented to time and place, I Olfactory (identify an odor or • Tremors or
recent and remote events, concentration and distinguish between 2 odors) involuntary
calculation) II Optic (visual acuity test) movements
Intellectual Function (education, vocabulary III Oculomotor (assess 6 cardinal
use, appropriate for age) eye movements & pupillary Sensation Status
Thought (logical, reasonable, speed, reaction) • Senses light touch
hallucinations, self-image, insight awareness) IV Trochlear (assess 6 cardinal • Senses pain or
eye movements) pricks
V Trigeminal (facial sensitivity & • Senses temperature
Glasgow Coma Scale biting/clinching teeth) • Senses vibration
VI Abducens (eye movement (tuning fork)
Eye Opening Verbal Response looking left and right)
Spontaneous 4 Oriented 5 VII Facial (smile, frown, raise Coordination
To Voice 3 Confused 4 brows, and taste) • Gait and stance
To Pain 2 Inappropriate Words 3 VIII Vestibulocochlear (hearing- Finger to nose Heel
None 1 Incomprehensible Words 2 rubbing fingers & equilibrium) to shin
None 1 IX Acoustic (gag reflex and Reflexes
Motor Response identify tastes) • Deep tendon
Obeys Commands 6 X Vagus (gag reflex and speech) reflexes (biceps,
Localizes Pain 5 XI Spinal accessory (head triceps, knees,
Withdraws (Pain) 4 movement and shoulder ankles)
Flexion 3 shrugging) • Plantar reflexes
Extension 2 XII Hypoglossal (stick out tongue
None 1 and move left and right)
Document as: E ___ + V ___ + M ___ = ____
2022 RANGER MEDIC HANDBOOK 95