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CRACKCast & Physicians as Humans on CanadiEM

CanadiEM aims to improve emergency care in Canada by building an online community of practice for healthcare practitioners and providing them with high quality, freely available educational resources. The CanadiEM Podcast brings you cutting edge clinical topics on the National Rounds Series and delves into the struggles that doctors face on the Physicians as Humans Series.

Oct 5, 2017

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