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Suicidal Patients Assessing And Managing Patients Presenting With Suicidal Attempts Or Ideation

August 2004

Abstract

Emergency physicians are often at the front lines in dealing with suicidal patients. This includes not only patients who present because of a suicide attempt, but also those who present with other chief complaints and have underlying suicidal intent that has not yet manifested itself. People at risk for suicide present in EDs in a variety of circumstances, with a variety of concerns (including mental and substance use disorders, physical abuse, recent losses, and painful physical illnesses) that can suggest an increased risk for suicide. One of the key challenges to the emergency physician is assessing the severity of that risk.

The role of the emergency physician in caring for those patients who have attempted suicide includes immediate medical evaluation and resuscitation when necessary, treatment of ingestions and acute injuries, maintenance of a safe and non-threatening environment, assessment of imminent suicide risk in consultation with emergency psychiatric services when available, and proper disposition with follow-up for discharged patients. For patients who are not overtly suicidal, the role of the emergency physician is to recognize risk factors and signs of possible suicidal ideation and to explore these with the patient in a non-judgmental way to determine the need for psychiatric or substance abuse referral.

Patients with suicidal intent or ideation are often treatable. Strategies to increase emergency physician awareness and referral of suicidal patients can save lives. This issue of Emergency Medicine Practice explores such methods.
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