Paucis Verbis: Assessing patients with suicidality in the ED
Dr. Rob Orman emailed me last week about creating a pocket card on Suicide Risk Stratification. In many community ED’s, risk assessment is done by the emergency physician. I’m lucky where I work, because we have a 24/7 psychiatric ED, which consults on suicidal patients in the “medical ED”.
In the end, assessment is primarily based on physician judgment, because there’s no great clinical decision tool, rules, or scores to assess risk. Rob has created his own mnemonic to help you ask the right questions in assessing a suicidal patient. This is a sneak peek into a larger article that Rob is planning to unleash on the world on suicide assessment. Based on his review of the literature and own clinical experience, the mnemonic is: TRAAPPED SILO SAFE.
TRAAPPED SILO
- “Risk factors” which increase a patient’s risk for committing suicide in the near future.
SAFE
- “Protective factors”which decrease a patient’s risk for committing suicide in the near future.
PV Card: Risk Stratification of Suicide
Go to ALiEM (PV) Cards for more resources.
Does your Emergency Department have computerized spectrophotometric catheters to measure continuous central venous oxygen saturation (ScvO2) in early goal directed therapy (EGDT) for severe sepsis? That’s what was used in the original Rivers’ EGDT study.
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How do you manage patients who present in status epilepticus, knowing that “time is CNS function”? The longer patients remain seizing, the greater their morbidity and mortality.