Question

question #4

you are requested by the police to assist them with an 18-year-old patient who is barricaded in a hallway. the scene is safe. neighbors say they saw the patient acting normal just a few minutes ago. you observe that the patient appears to be hallucinating. what is your first consideration?

was the patient recently fired from work?
was there a recent fight with a significant other?
has the patient ever had a mental health exam?
did a medical cause bring on this behavioral disturbance?

Explanation:

Analyze the clinical presentation

The patient is an 18-year-old who suddenly began acting abnormally and appears to be hallucinating. Neighbors report the patient was acting completely normal just a few minutes prior. This extremely rapid onset of behavioral changes and hallucinations is a key clinical indicator.

Evaluate potential etiologies

Psychiatric illnesses (such as schizophrenia or bipolar disorder) typically develop gradually over weeks or months rather than presenting as sudden, acute hallucinations in a patient who was normal minutes ago. A sudden onset of altered mental status or behavioral disturbance strongly points toward an underlying acute medical cause, such as substance ingestion, toxin exposure, hypoglycemia, hypoxia, head trauma, or infection.

Apply EMS assessment priorities

In Behavioral Emergencies, the first and most critical consideration after ensuring scene safety is to rule out a treatable medical or traumatic cause (Trauma vs Medical Etiology). Treating a behavioral crisis as purely psychiatric when it is caused by a medical emergency (like hypoglycemia or hypoxia) can lead to severe patient harm or death. Therefore, the first consideration must be: "Did a medical cause bring on this behavioral disturbance?"

Answer:

• Was the patient recently fired from work?
• Was there a recent fight with a significant other?
• Has the patient ever had a mental health exam?
• Did a medical cause bring on this behavioral disturbance? (Correct answer)