This episode covers Chapter 105 of Rosen's Emergency Medicine (9th Ed.), Suicide.
Episode Overview:
- Suicide is a common but preventable cause of death
- Suicide is usually triggered by treatable or reversible short-term crises
- Most attempted suicide survivors are grateful to be alive
- Suicide risk changes over time; estimations of imminent risk are NOT evidence-based
- Routine screening labs provide little value to most ED patients with self-harm behaviours
- Evaluations should be targeted to signs or symptoms of disease on presentation
- Any ED visit for suicidal thoughts or behaviours represents a crisis and a teachable moment
- With your approach, it is important to be supportive, empathetic, and patient-centred
- Have a collaborative plan that integrates the input from collateral sources
- When caring for suicidal patients, use precautions:
- Sitters
- Physical/chemical restraints
- Involuntary admission forms
- Brief and focused risk assessment of patients in the ED can identify persons in need of further comprehensive evaluation and consultation with a mental health specialist
- Those patients who are deemed to be at low-risk of suicide may be discharged home to a safe and supportive environment, assuming they have no access to toxic medications or guns
- They should receive education and safety planning in the ED
- They should have early mental follow-up appointments
Core questions:
- Name 10 risk factors for suicide
- Name an additional 5 risk factors for adolescent suicide
- Describe the SAD PERSONS Scale
- Describe 4 potential targeted investigations for patients presenting to the ED with suicide
- Name 3 protective factors for against suicide
