Not Just a Psych Issue
A patient with a history of alcohol use disorder is brought to the ED for acute confusion and paranoia. On exam, you notice they are stumbling when they walk and have involuntary, jerky eye movements. This condition must be treated before administering any intravenous glucose.
Wernicke’s Encephalopathy
This incredibly common over-the-counter cough suppressant is notorious for causing a false positive for Phencyclidine (PCP) on standard immunoassay urine drug screens
Dextromethorphan (DXM)
True or False: Placing a patient on an involuntary psychiatric hold automatically grants the medical team the legal right to force non-emergency medical procedures (like an MRI or a blood draw) against their will
False
A 24-year-old female with a history of depression presents with acute paranoid psychosis, severe insomnia, and strange, dance-like choreoathetoid movements. A basic medical workup is normal, but a pelvic ultrasound reveals an ovarian teratoma. This is the underlying autoimmune condition causing her symptoms.
Anti-NMDA Receptor Encephalitis
This highly potent synthetic opioid class, responsible for the vast majority of modern overdoses, will show up as completely negative on a standard, basic urine toxicology screen.
Fentanyl
A violently combative, delirious patient is actively throwing punches at ED staff. A psych resident hesitates to give intramuscular sedation because the formal involuntary psychiatric hold paperwork hasn't been signed yet. This legal doctrine protects the clinician and allows immediate sedation without a signed hold or consent
Emergency Exception to Informed Consent
If a patient presents with catatonia, fluctuating levels of consciousness, and subtle lip-smacking, you must order this diagnostic test to rule out a hidden neurological emergency.
EEG (Electroencephalogram)
This widely prescribed antidepressant, commonly used for major depressive disorder and smoking cessation, is the most notorious prescription drug for triggering a false positive for amphetamines/methamphetamines
Bupropion and Trazodone
If an intoxicated patient with a blood alcohol content of 0.25% demands to leave the ED against medical advice (AMA), this is the primary legal reason they cannot sign out
inability to demonstrate decision-making capacity due to acute intoxication
A patient presents with acute-onset visual hallucinations, severe abdominal pain, and weakness in their arms and legs. Their urine turns a distinct reddish-brown color when left standing under light. This rare metabolic disorder must be ruled out immediately before administering standard antipsychotics, which can worsen the condition.
Acute Intermittent Porphyria (AIP)
Because of its highly unpredictable half-life and tendency to deposit heavily in adipose tissue, a positive UDS for this substance does not inherently mean the patient is acutely intoxicated today
Cannabis / THC
To legally establish that a patient has the capacity to refuse a critical medical workup, they must satisfy these four specific cognitive criteria
1) Communicating a choice, 2) Understanding the relevant information, 3) Appreciating the situation and its consequences, and 4) Reasoning through the options