Understanding ACEP’s Clinical Policy on Seizures

Understanding ACEP’s Clinical Policy on Seizures

ACEP's 2014 Seizure Guidelines

A point-by-point review by Dr. Rhonda Cadena  

Mid-Level Providers

Mid-Level Providers

Who they are, what they do, and why they’re changing emergency medicine

How to make sense of the puzzle and improve your practice.

When Patients Lie

When Patients Lie

How to Spot Deception, What You Can Do, and Why it Matters

Accusing anyone of lying is serious business, but when that person is your patient, the stakes are even higher. 

Raves and Saves

Raves and Saves

Advanced Emergency Management at Mass Gatherings

EM is crucial at drug-fueled electronic dance festivals, like this month’s Electric Zoo in New York.  

Transfusion Confusion

Transfusion Confusion

Knowing the Real Risks of Blood Transfusion

This routine procedure bears real risks and should be handled accordingly.

The ABCs (and T) of Rural EM

The ABCs (and T) of Rural EM

Situational Awareness is Key

When you’re practicing in the middle of nowhere, planning out a timely patient transfer can be as critical as securing…

DNR Means Do Not Treat . . . and Other End-of-Life Care Myths

DNR Means Do Not Treat . . . and Other End-of-Life Care Myths

Debunking 5 Fallacies

Improve your EOL care and communicate more effectively.

Through the Looking Glass

Through the Looking Glass

Three Novel Use Cases for Google Glass in the ED

How might augmented reality change your practice?

Augmented ED

Augmented ED

The future of emergency medicine?

EPs in Rhode island overcome hurdles to trial Glass for telemedicine and consider other applications.

All About Metoclopramide (Reglan)

All About Metoclopramide (Reglan)

Know the risks

Reglan should be used with caution if patients have Parkinson’s disease or are on antipsychotics.

Physicians Won't Be Silenced

Physicians Won't Be Silenced

ACEP's Gag Order Rejected

EPM readers speak out against ACEP’s new ruling prohibiting incoming leaders from answering questions from non-ACEP publications.

Changemaker

Changemaker

How One EP Transformed Mental Health Admissions in Virginia

Debra Perina combined her experience as a coroner with her time leading an ED to challenge the establishment.

Get the Gear Off

Get the Gear Off

Removing the Helmet and Pads is Crucial to Treating Spinal Injuries from Football

Up to 25% of c-spine injuries from football collisions may be exacerbated by the poor removal of helmet and pads.

The War on Death

The War on Death

by Greg Henry, MD

The guns and butter debate is really over, I guess.

How Do I Know if I'm Being Paid Fairly?

How Do I Know if I'm Being Paid Fairly?

Trust is key

I get paid based on my productivity, but I don't trust that my company is paying me accurately.

The Stethoscope of the Future

The Stethoscope of the Future

Bedside Ultrasound

The applications of bedside ultrasound have gone well beyond scanning the gallbladder . . . to the lungs?

The Medical Malpractice Rundown: A State-by-State Report Card

The Medical Malpractice Rundown: A State-by-State Report Card

When it comes to medical liability laws and culture, where you live matters.

Find out how your state stacks up against the other 49.

Gag Order

Gag Order

New ruling prohibits would-be ACEP leaders from answering questions from non-ACEP publications.

Greg Henry seldom fails to deliver on a promise. But this time, it looks like it’s out of his control.

Oxygen is a Drug— Act Accordingly

Oxygen is a Drug— Act Accordingly

Understanding the dangers of indiscriminate oxygenation in the ED setting

As with many things in medicine, dogma seems to overpower the evidence in this arena. 

Frontpage Slideshow | Copyright © 2006-2014 JoomlaWorks Ltd.
Print
E-mail
Reprint
Review by Ryan Petersen, M.D.
Column organized by Evan Schwarz, M.D.
Washington University in St. Louis
Division of Emergency Medicine
 
Doshi, A, Boudreaux, ED, Wang N, et al.  National Study of US emergency department visits for attempted suicide and self-inflicted injury, 1997-2001.  Ann Emerg Med.  Oct 2005; 46 (4):  369-375.
 
While working an evening shift in the emergency department you encounter an 18-year-old female who has attempted suicide by Tylenol ingestion.  Her exam is unremarkable, but her past history is significant for depression and alcohol abuse.  As you order labs, you wonder what type of patient typically presents with a suicide attempt, what means do they use, and if they are at a greater risk to complete suicide.

Suicide is the eighth leading cause of death within the United States, and is responsible for approximately 30,000 deaths annually. It accounts for more than 400,000 ED visits per year. The majority of epidemiologic studies have focused on completed suicide rather than on suicide attempt or intentional self-injury.  The attempted to completed suicide ratio is 8:1, thus many of these studies fail to define the typical case that presents to an emergency department.  This article employs data from the National Hospital Ambulatory Medical Care Survey to further define this population of patients.
Visits for attempted suicide and self-inflicted injury accounted for 0.4% of the total ED visits between 1997 and 2001.  ED visits varied according to age, sex, and race.  The mean patient age was 31 years old and visits were most common among 15 to 19 year olds.
 

Age

 

Rate (per 1,000 ED visits)

 

15-19 years old

 

3.3

 

20-29 years old

 

2.9

 

30-49 years old

 

2.0

 

Sex

 

 

 

 

Males

 

1.3

 

Females

 

1.7

 

Race

 

 

 

 

White

 

1.5

 

African American

 

1.9

 

 
However other studies concluded that whites have a higher rate of suicide attempts than African Americans.  The most common method of attempted suicide was poisoning (68%), cutting/piercing instruments (20%), hanging (<1%) and firearms (<1%).

Suicide attempts were associated with psychiatric disorders and alcohol abuse.  Psychiatric disorders were coded in 55% of those presenting with a suicide attempt, with depressive disorder being present in 18%. Alcohol abuse was present in 9%.  Between 40-60% of people who commit suicide are intoxicated at death.  With psychiatric conditions and intoxication being so prevalent in this population, it is very important to document mental status exam and suspicion of intoxication if an alcohol level is not ordered.  Only 43% of charts included a mental status exam and only 25% had an ethanol level.  Suicide is the third leading cause of death among 15 to 24 years olds.  This may be due to factors such as self-doubt, pressure to succeed, and role confusion.  Either way the ED may be their first point of contact with health care in order to get help. 
The populations of patients who present with suicide attempt vary greatly when compared to those who have completed suicide.  Patients who complete suicide are typically older, men, living alone, physically ill, and utilize a more lethal means of suicide.  In contrast, those who attempt suicide are younger, women with psychosocial risk factors such as depression, substance abuse, and other mental disorders.  It should be kept in mind that these patients can still have significant injuries as one third are admitted with one third of those being admitted to the ICU.  Evidence suggests that those who present with a suicide attempt have a significant risk of eventually completing suicide.  As emergency department physicians, we have a unique task of identifying these patients.  This is made more challenging as attempted suicide trended to be more common at night than the trend for overall ED visits when many of the resources these patients need may not be available.  Scales such as the SAD PERSONS and Manchester Self-Harm Rule are available to help risk stratify patients.  Proper assessment and clinical management may help prevent suicide and future suicide attempts.
 
 

Add comment

Security code
Refresh

Popular Authors

  • Greg Henry
  • Rick Bukata
  • Mark Plaster
  • Kevin Klauer
  • Jesse Pines
  • David Newman
  • Rich Levitan
  • Ghazala Sharieff
  • Nicholas Genes
  • Jeannette Wolfe
  • William Sullivan
  • Michael Silverman

Subscribe to EPM