Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Physiological instability or acute brain syndrome
Abnormal airway, breathing or circulation, hypoglycaemia, hyperthermia, fluctuating consciousness, seizure, focal deficit, severe rigidity or suspected poisoning requires emergency medical care before psychiatric placement.
Action: Use ABCDE, obtain bedside glucose and observations, call appropriate emergency support and begin cause-directed treatment. Preserve samples and toxicology information when relevant, use safe restraint only if immediately necessary, and ensure transfer to a setting able to manage the physical risk.
Synopsis
Use history-led physical examination and proportionate baseline tests to identify acute medical or neurological causes, establish safe treatment parameters and avoid both diagnostic overshadowing and indiscriminate investigation in psychiatric presentations.
Start with vital signs, oxygen saturation, consciousness and bedside glucose when illness, intoxication, withdrawal or altered behaviour could reflect physiological disturbance.
Perform a complete examination when presentation is acute or unexplained, adding focused neurological, cardiovascular, endocrine, injury, infection and nutritional assessment from the history.
Select tests to answer stated questions; there is no universal blood panel that proves a presentation is medically cleared for psychiatric care.
Key red flags
First psychiatric symptoms after age 40, abrupt onset, rapid progression or prominent cognitive change should lower the threshold for medical and neurological investigation.
Investigation priorities
01
Immediate observations and bedside glucoseFirst step
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.