20 Medical emergencies

Here is the same list of 20 medical emergencies most likely to occur in a forensic psychiatric hospital, now presented in English:

1. Suicide Attempt & Self-Harm – The highest-priority risk; patients may use any opportunity to hang, cut, or inflict head trauma on themselves.
2. Violence & Aggression – Sudden physical attacks against other patients or staff, potentially resulting in severe trauma, fractures, or lacerations.
3. Acute Psychotic Episode – Severe hallucinations, delusions, and psychomotor agitation leading to complete loss of behavioral control.
4. Catatonic or Depressive Stupor – Prolonged immobility, mutism, and refusal to eat or drink, leading to dehydration, malnutrition, and bedsores.
5. Medication Overdose – Patients hoarding prescribed psychotropic medications for a single intentional ingestion, or using illicit substances.
6. Neuroleptic Malignant Syndrome (NMS) – A rare but life-threatening complication of antipsychotic drugs, characterized by hyperthermia, muscle rigidity, and altered consciousness.
7. Serotonin Syndrome – Often caused by overdose or drug interactions involving serotonergic agents, presenting with hyperthermia, agitation, and myoclonus.
8. Seizures – Some patients have comorbid epilepsy, while others (especially those on clozapine) have a lowered seizure threshold; management is complicated by security protocols.
9. Falls & Fractures – Extremely common due to sedation, orthostatic hypotension from psychotropics, or impulsive running; hip fractures are notably frequent.
10. Substance Withdrawal Syndromes – Particularly alcohol or benzodiazepine withdrawal, which can progress to life-threatening delirium tremens.
11. Acute Delirium – Caused by infections, electrolyte imbalances, or medications; presents with confusion and severe agitation, carrying high mortality risk if untreated.
12. Anaphylaxis – Severe allergic reactions to newly introduced psychotropic medications, other drugs, or food items.
13. Aspiration Pneumonia – Occurs after vomiting or regurgitation in stuporous patients, those having seizures, or those over-sedated, leading to lung infection.
14. Severe Extrapyramidal Symptoms (EPS) – Acute dystonia (e.g., oculogyric crisis) or severe akathisia; not immediately fatal but extremely distressing and requires urgent intervention.
15. Lithium Toxicity – With a narrow therapeutic window, lithium levels can rise due to dehydration or renal changes, manifesting as tremor, ataxia, and coma.
16. Acute Coronary Syndrome – Patients with severe mental illness have significantly higher cardiovascular risk; may present as chest pain, arrhythmia, or sudden cardiac arrest.
17. Pulmonary Embolism – Resulting from deep vein thrombosis due to prolonged immobilization or physical restraint use.
18. Septic Shock – Evolving from common infections such as pneumonia or urinary tract infections, which are frequent in this population.
19. Acute Urinary Retention – A common side effect of medications with strong anticholinergic properties; causes extreme distress and requires immediate catheterization.
20. Patient Absconding / Escape – In a high-secure setting, a patient attempting to flee the ward or hospital perimeter is a major security and medical emergency (due to risk to self and public).

Here is a practical, easy-to-follow numbered list for all 20 emergencies. For each situation, I’ve listed observable symptoms (what you can see) and specific nurse actions (what to do right away).

1. Suicide Attempt & Self-Harm

• What you see: Bleeding wounds, ligature marks around the neck, a patient slumped over, unconsciousness, or a patient holding a sharp object.
  
• What a nurse should do: Call a code/emergency team. Open the airway and check breathing. Apply direct pressure to bleeding wounds with a clean cloth. Do not remove a ligature if the patient is upright (support them and cut it only after supporting the body). Stay with the patient at all times. Remove all dangerous items from reach afterward.
  

2. Violence & Aggression

• What you see: Shouting, clenched fists, throwing furniture, kicking, or attacking another person.
  
• What a nurse should do: Call security and backup staff immediately. Keep a safe distance (arms' length). Use calm, simple commands ("Sit down"). Remove other patients from the area. Do not turn your back. Only physically intervene as a team using approved restraint techniques, or give prescribed rapid tranquilization medication (IM) if ordered.
  

3. Acute Psychotic Episode

• What you see: Talking to unseen people, extreme fear, bizarre posturing, pacing, or responding to internal voices.
  
• What a nurse should do: Reduce noise and bright lights. Speak slowly and calmly. Do not argue with delusions. Offer PRN (as-needed) antipsychotic medication as prescribed. Ensure the patient does not harm themselves during agitation. Monitor for exhaustion and dehydration.
  

4. Catatonic or Depressive Stupor

• What you see: Patient lying or sitting completely still, not speaking, not eating or drinking, staring blankly, and possibly incontinent.
  
• What a nurse should do: Check vital signs (pulse, breathing) regularly. Position the patient to prevent bedsores. Do not force food or drink (risk of choking) – request IV fluids. Monitor for fever or infections. Speak gently and explain everything before touching them.
  

5. Medication Overdose

• What you see: Extreme drowsiness, shallow or slow breathing, vomiting, dilated or tiny pupils, or unresponsiveness.
  
• What a nurse should do: Call a medical emergency team. Check airway, breathing, and pulse. Bring the patient's medication chart to the doctor. Do not induce vomiting. Prepare for activated charcoal or specific reversal agents (e.g., flumazenil for benzos) if ordered. Monitor oxygen saturation.
  

6. Neuroleptic Malignant Syndrome (NMS)

• What you see: Very high fever (above 38°C/100.4°F), severe muscle stiffness (like a board), heavy sweating, confusion, and fast heart rate.
  
• What a nurse should do: Stop all antipsychotic medications immediately (inform the doctor). Remove extra blankets and use a cooling fan or tepid sponging. Give IV fluids as ordered. Monitor urine output (risk of kidney failure). Prepare for transfer to a general hospital.
  

7. Serotonin Syndrome

• What you see: Agitation, rapid heart rate, sweating, muscle twitching (especially in the legs), dilated pupils, and diarrhea.
  
• What a nurse should do: Stop all serotonergic drugs (antidepressants, etc.) and inform the doctor. Keep the patient calm in a quiet room. Give IV fluids and cooling measures. Give benzodiazepines as prescribed to control twitching. Monitor breathing closely.
  

8. Seizures

• What you see: Falling to the floor, rhythmic jerking of arms/legs, eyes rolling back, drooling, or confusion after the episode.
  
• What a nurse should do: Clear the area of furniture. Place a soft item under the head. Do not put anything in the mouth. Time the seizure. If it lasts longer than 3 minutes, call a code. After jerking stops, place the patient in the recovery position (on their side). Check oxygen and give rescue medication (e.g., midazolam) if ordered.
  

9. Falls & Fractures

• What you see: Patient lying on the floor, complaining of pain, unable to move an arm or leg, swelling or bruising, or holding a limb at an odd angle.
  
• What a nurse should do: Do not move the patient immediately – check for neck or spine injury. Call for help and a doctor. Immobilize the injured limb with a pillow or splint. Apply ice if allowed. Check vital signs and pupil response (for head injury). Arrange an X-ray.
  

10. Substance Withdrawal (Alcohol/Benzos)

• What you see: Shaking hands, sweating, nausea, extreme anxiety, hallucinations (seeing bugs), or confusion.
  
• What a nurse should do: Use a withdrawal scale (e.g., CIWA) to assess severity. Give prescribed benzodiazepines according to the scoring protocol. Keep the room dim and quiet. Offer small sips of water. Monitor vital signs every 15–30 minutes for spikes in blood pressure or heart rate.
  

11. Acute Delirium

• What you see: Sudden confusion, rambling speech, picking at bedclothes, not recognizing familiar people, and agitation that comes and goes.
  
• What a nurse should do: Check for a recent infection, constipation, or dehydration (common triggers). Reorient the patient gently – tell them the date, place, and who you are. Keep a light on at night. Avoid physical restraints if possible; use sitters or one-to-one observation. Call the doctor for a medical workup.
  

12. Anaphylaxis

• What you see: Skin rash/hives, swollen lips or tongue, wheezing, difficulty breathing, dizziness, or a weak, fast pulse.
  
• What a nurse should do: Call a code immediately. Remove the trigger (e.g., stop the IV drug). Lay the patient flat (elevate legs if possible). Give intramuscular epinephrine (adrenaline) if standing orders allow. Give high-flow oxygen. Prepare for CPR if breathing stops.
  

13. Aspiration Pneumonia

• What you see: Gurgling sounds while breathing, coughing or choking during/after eating, fever, rapid shallow breathing, and green/yellow sputum.
  
• What a nurse should do: Turn the patient onto their side immediately. Suction the mouth and throat if available. Check oxygen saturation – give oxygen if low. Call a doctor for a chest X-ray and antibiotics. Keep the head of the bed elevated for all meals and drinks from now on.
  

14. Severe EPS (Acute Dystonia or Akathisia)

• What you see: Eyes rolling upward, neck twisted to one side, tongue sticking out, or constant rocking/pacing with severe inner restlessness.
  
• What a nurse should do: Reassure the patient that this is treatable (akathisia causes extreme fear). Give prescribed anticholinergic medication (e.g., benztropine or diphenhydramine) orally or IM. Monitor swallowing – if dystonia affects the throat, prepare for airway support. Document and report to the prescriber to adjust the antipsychotic dose.
  

15. Lithium Toxicity

• What you see: Severe hand tremor, nausea, vomiting, slurred speech, drowsiness, and unsteady walking.
  
• What a nurse should do: Stop the next lithium dose and call the doctor. Draw blood for an urgent lithium level. Encourage fluids if the patient can swallow, or start IV fluids as ordered. Monitor urine output closely. Watch for worsening confusion or seizures.
  

16. Acute Coronary Syndrome (Heart Attack)

• What you see: Chest pain/pressure, sweating, shortness of breath, pain radiating to the left arm or jaw, or sudden collapse.
  
• What a nurse should do: Call a cardiac code. Sit the patient up (semi-recumbent). Give 300 mg aspirin to chew if prescribed and no allergy. Apply oxygen and attach an ECG monitor. Stay calm and prepare for transfer to a medical hospital – do not delay.
  

17. Pulmonary Embolism

• What you see: Sudden shortness of breath, sharp stabbing chest pain (worse with breathing), coughing up blood, and very fast heart rate.
  
• What a nurse should do: Call an emergency code immediately. Give high-flow oxygen. Lay the patient flat or semi-recumbent – do not let them walk. Check pulse oximetry. Prepare for urgent transfer to a general emergency department (they need a CT scan and clot-busting drugs).
  

18. Septic Shock

• What you see: High fever (or abnormally low temperature), fast heart rate, low blood pressure, confusion, and warm or cold/clammy skin.
  
• What a nurse should do: Call the doctor urgently. Draw blood cultures before antibiotics if possible. Give IV fluids rapidly as ordered. Start broad-spectrum antibiotics per protocol. Measure urine output with a catheter if needed – low output means kidney stress. Monitor temperature hourly.
  

19. Acute Urinary Retention

• What you see: Severe lower abdominal pain (patient clutching their belly), inability to pass urine for many hours, a visibly bulging lower abdomen, and extreme distress/restlessness.
  
• What a nurse should do: Try simple measures – running tap water or offering warm fluids. If no success, call the doctor for a bladder scan. Prepare for sterile in-out catheterization as ordered. Monitor for sweating or high blood pressure during the procedure (autonomic reflex).
  

20. Patient Absconding / Escape

• What you see: Patient running toward an exit, climbing over a fence, hiding near doors, or tampering with locks.
  
• What a nurse should do: Press the security alarm immediately – do not chase alone. Verbally command the patient to stop. Follow facility lockdown protocol (close all external doors). Count all other patients to ensure none are missing. Do not physically block the exit alone – wait for backup. Prepare a description (clothing, height) for security search teams.