Mental health (psychiatric) emergencies

Anxiety

Anxiety is the most common psychiatric symptom and can range from appropriate and adaptive minor doubts about success to a full-blown panic reaction. Specific fears, such as an aversion to heights, are called “phobias.” Minor anxiety is expressed as general apprehension about a situation that is perceived in some way to be dangerous. The excessive worrier might become timid and withdrawn, and might lose their enthusiasm for participation. Their anxiety might be clothed in criticism of plans or refusal to cooperate. Some people suffer from general, free-floating anxiety. It’s important that every member of the expedition voice fears and objections at the outset, so as not to be caught in a panic when crossing treacherous terrain or performing rescues.

The treatment is reassurance and support. Frequently, practice sessions that build up to a completed effort will relieve anxiety and improve the performance of the group. In no case should anyone be made to feel ashamed of their fears. Rather, the leader should seek to help the victim conquer them.

Approach what problems you can directly. Most people do much better if fear is identified and managed than if it is never confronted.

In certain circumstances, in which anxiety must be treated to allow extrication, rescue, or even survival, judicious use of an antianxiety drug, such as lorazepam (Ativan) 0.2 to 2 mg, alprazolam (Xanax) 0.5 mg, or diazepam (Valium) 2 to 5 mg, might be useful. Persons who suffer chronically from anxiety might already be taking one of these medications. If they run out of medication or stop taking it for another reason, they can enter a withdrawal (from their physiological addiction) state. They will be agitated, perhaps paranoid, unable to sleep, have diffuse muscle aching, be shaky, complain of rapid heart rate, and perhaps suffer a seizure. They can become very seriously ill from benzodiazepine (type of drug) withdrawal and need to be promptly properly medicated.

Panic

Panic is anxiety in the extreme. Signs and symptoms can include heart palpitations, sensation of pounding heart, rapid heart rate, sweating, trembling or shaking, shortness of breath or a sensation of “smothering,” choking sensation, chest discomfort, nausea, dizziness, fainting, a sensation of loss of reality, and fear of dying. The victim loses all judgment and becomes consumed with efforts at escape and self-preservation. Panic renders the victim unable to make reasonable decisions and immediately places them and all around them at risk for injury. The rescuer might need to assume a strong authoritative posture with the panic victim, assuring them in no uncertain terms that the situation is under control and the panic behavior is detrimental. Depending on the situation, this can be done with verbal explanations, convincing arguments, or demonstrations of safety. As for anxiety, antianxiety drugs such as lorazepam might be helpful. If the victim places other individuals at immediate risk for injury, they should be subdued, with force if necessary.

Persons who use cocaine, marijuana, phencyclidine (PCP, angel dust), methamphetamine (speed), or hallucinogens are prone to panic reactions under conditions of stress. Certain drugs, such as PCP and methamphetamine, are associated with violent behavior. If a person appears to be under the influence of drugs, do your best to keep them from hurting themself or anyone else, but be careful not to become injured yourself in the process.

One manifestation of anxiety that verges on panic is the hyperventilation syndrome, in which the victim overcome by their fears, begins to breathe at a rate of 40 to 100 times per minute. This causes the level of carbon dioxide in their blood to fall precipitously and to render the blood alkaline (from its normal neutral state). The symptoms are dizziness; fainting spells; numbness and tingling in the hands, feet, and around the mouth; muscle spasm in the hands and wrists; and, occasionally, seizures. If you’re certain that the victim is hyperventilating because of anxiety (that is, there is no reason to suspect a collapsed lung [see page 47], pneumonia [see page 55], asthma [see page 52], diabetic ketoacidosis [see page 163], or other medical problem), encourage slow regular breathing. The old-fashioned therapy used to be to place a paper bag or similar device over the mouth and nose for about 5 minutes and have the victim breathe in and out of this bag to rebreathe their own expired carbon dioxide, theoretically allowing more rapid normalization of the level in the bloodstream and correction of symptoms. However, since insufficient oxygen is available to the victim while rebreathing from the bag, this technique might be dangerous for persons with heart or lung disease. If there is a clean length of wide tubing (e.g., garden hose) of approximately 12 to 18 inches, the victim can breathe through the tubing to increase the amount of retained carbon dioxide while still having access to adequate oxygen, until symptoms abate. However, since this tubing is not likely to be present, the most important intervention will probably be to attempt to calm the victim in order to lessen the breathing rate. After the episode, make an attempt to identify the cause of the anxiety.