This episode covers Chapter 105 of Rosen's Emergency Medicine (9th Ed.), Suicide.

Episode Overview:

• Suicide is a common but preventable cause of death
• Suicide is usually triggered by treatable or reversible short-term crises
• Most attempted suicide survivors are grateful to be alive
• Suicide risk changes over time; estimations of imminent risk are NOT evidence-based
• Routine screening labs provide little value to most ED patients with self-harm behaviours
• Evaluations should be targeted to signs or symptoms of disease on presentation
• Any ED visit for suicidal thoughts or behaviours represents a crisis and a teachable moment
  • With your approach, it is important to be supportive, empathetic, and patient-centred
  • Have a collaborative plan that integrates the input from collateral sources
• When caring for suicidal patients, use precautions:
  • Sitters
  • Physical/chemical restraints
  • Involuntary admission forms
• Brief and focused risk assessment of patients in the ED can identify persons in need of further comprehensive evaluation and consultation with a mental health specialist
• Those patients who are deemed to be at low-risk of suicide may be discharged home to a safe and supportive environment, assuming they have no access to toxic medications or guns
  • They should receive education and safety planning in the ED
  • They should have early mental follow-up appointments

Core questions:

1. Name 10 risk factors for suicide
2. Name an additional 5 risk factors for adolescent suicide
3. Describe the SAD PERSONS Scale
4. Describe 4 potential targeted investigations for patients presenting to the ED with suicide
5. Name 3 protective factors for against suicide