fx Records (HIM Archive) Date: 29/03/27 25105 |wGRT, DOAN GTA Fac: thunber River Hospital Loc:Wilson Smergency Bed: 31 M 20/11/1985 Med Rec Wum:1i00144 6022 Wisdt:£8199537/17 ‘Attending: Rag Date: 22/03/17 ‘Reason: DEPRESSION-BIZZARE BEHAVIOUR ED Activity hast Name: NGHIEM Status Pinal Discharge IPiret Nane+ DOAN ‘Triage Levelt 3 CTAS URGENT fide: Gra. condition 20/11/1385 Arrival Date/Time: 28/03/17 11:41 31 Arrival Moder Malle Tn " ‘Triaged Ate 28/03/17 11:43 Hhanguage: English Time Seen by Providers 28/03/17 12:51 [Stated Complaint: DEPRESSTON-BIZEARE BERAVIOUR lcniez complaint: Bizeare behaviour leD Lecation: Sub-Reute larca |scation: seoun: len Provider peniea lkD tidlevel Provider leb Wurse: primary care Provider Kibreab, Elias ‘Status/Phase DeTm/Value User/Action mp2c MD to see 28/03/17 12:57:10 | Denissova,Daria Ed Provider Dr, Daria Denissova Edit REG istered 28/03/17 12:31:13 | Kibreab Elias Ed Nurse: Kibreab Elias New 28/03/17 11:59:43 | DeCiceo, Tent Ed Provider EDM-DR New RECEIVED 28/03/17 11:43 | Antonucci, Domenica Chief Complaint Bizzare behaviour New 28/03/17 11:41:33 | Antonucci Domenica ‘Stated Complaint DEPRESSION-BIZZARE BEHAVIOUR | New [28/03/17 13:10 Nursing Notes by Achioso,Chidimme \Chiet Complaint: "Bizarre Behavior" lHistory of present illness: as per triage note “PT. C/O BILATERAL WRIST PAIN D/T HANDCUFFS. AT 1030 IPT. STATES HE BECAME INFLAMMED, C/O DEPRESSION, STATES HE DOES NOT WISH TO BE IN THIS COUNTRY. BEGAN THROWING ITEMS OFF THE BALCONY. ELDERLY PARENTS DON'T SPEAK ENGLISH. POLICE| [CALLED AND PT. WAS APPREHENDED. C/O DEPRESSION AND WANTING TO "ARTISTICALLY" EXPRESS HIMSELF BY THROWING THINGS". lAllergy: Denied any known allergy. Continued on Bage 2 This forms a part of the patient's madical record.Fae: Hunbor River Hospital Loe:Witeon smergen: 31 M 20/11/1985 Med Rec Wum:H001046022 lHousing: Lives with parents in apartment lFinancial Support: Current unemployed. Last worked earlier January. Stated he was working in Yorkdale Mail in the theater \Substance Use: Client denied any substance use. IMedical Condition: Client denied any medical condition st Mental Health Histor Ibehavior. jenied past history however he was seen by Dr, Salama in 2014 for similar |Family History of mental Health: Client denied any family history of mental Health Psychosocial History: 33 year male who was presented to ED by the police after parents called for bizarre Ibchavior. As per police, Parents stated client has acting strange, throwing dumbbell down from the balcony, leoging neighbor's door, throwing water. Upset because dad was shaving. Stated father is “accepting of his Ibelief'. Client denied any medical history, any allergy, or any psychiatric problem. Stated he Is overwhelmed Iwith life, Feels he is not progressing and in so much debt. Stated he dropped out school. Was studying lcoronary at Humber college. Client is the only child of the family. Parents are old and retired. Mental Status Examination: On mental status assessment, client was calm and cooperative. Stated he |was “inflamed” and constipated for the past 2 to 3 days. Stated when he feels toxics in his body he becomes "over inflamed. Could nat elaborate on what what he means by “inflamed”. Client endorsed feeling \depressed. Stated he is overwhelmed with life, not getting along with parents and not progressing in life linstead going "backwards", Client stated he stopped going to work earlier in January 2014 because he could Inot handle tt. Currently supported by the parents. Client denied any suicidal homicidal ideation however, |police report stated client endorsed homicidal ideation, Stated he said “he wants to kill other". Client ladamnantly denied such but stated "unless throwing egg and liquid can kill". Police also stated that parents Ihas been isolating himself and secluded toself. Not coming out and nat engaging. Client remains calm, affect lis fat and in stable mood. IRisk: Client denying suicidal ideation, at risk of hurting others by throwing things around. limpression: Client may be in prodromal stage. Further assessment may be required. Bizarre behavior. Lacks coping strategies dealing with stressful situations, Recommendation: Suggasted UTOX to rule out substance use/ inducad psychosis. ARC's referral may be Jbeneficial to help dient connect. To be reassessed by the psychiatrist. Disposition: client awalts EPU bed. Placed on Form 1 by the ED GP. Psychiatrist to assess. linitialized on 28/03/17 13:10 - END OF NOTE |28/03/17 13:10 Emergency Physician by Denissova,Daria Patient brought in by police. He building manager called thern because the patient wes behaving lagressively. This morning, his father was shaving and that made the patient angry so he threw a dumbbell lout the windew onto the street and just missed a car. Over the last 2 weeks the parents have naticed that ithe patient has been more sad but also at times aggressive and angry. They have been fearful for their own lsafety. He recently found that the neighbor downstairs is making too much noise and the door of his lapartments. The patient is complaining of insomnia and feeling “inflamed”. He is unable to explain what he Continued on Ba’ This forms a part of the patient's medical recordFae: Hunbor River Hospital Loe:Witeon smergen: 31 M 20/11/1985 Med Rec Wum:H001046022 |means by that. She denies drug alcohol and cigarette use. Previous medical history: Denies any medical or psychiatric history Medications: No medications according to the patient, Physical exam: Patient is alert. He is cooperative and calm. Eye contact is appropriate. Slightly flattened affect. Denies [suicidal or homicidal ideation. Denies auditory or visual hallucinations. INo signs of self-harm. \cood air entry bilaterally, heart sounds are unremarkable. JAbdomen Is soft, no pain, no rebound. limpression and plan: Prodrome to schizophrenia? Given his aggressive and inappropriate behavior will put ithe patient on form and have him assessed by psychiatry. Wvital Signs Temp _| Pulse | Resp | BP Pulse Ox 28/03/17 12:44 | 36.4] 61 | 19 | 97/63_| 97 28/03/17 11:43 | 36.6C| 61 | 16 | 108/71 | 97 ** Electronically signed by Denissova, Daria, MD on 28/03/17 13:13 ** linitiaized on 28/03/17 13:10 - END OF NOTE Patient Notes |28/03/17 13:10 Nursing Notes by Achioso,chidimma \chiet Complai "Bizarre Behavior" lHistory of present illness: as per triage note “PT. C/O BILATERAL WRIST PAIN D/T HANDCUFFS. AT 1030 IPT. STATES HE BECAME INFLAMMED. C/O DEPRESSION, STATES HE DOES NOT WISH TO BE IN THIS COUNTRY. BEGAN THROWING ITEMS OFF THE BALCONY. ELDERLY PARENTS DON'T SPEAK ENGLISH. POLICE| [CALLED AND PT. WAS APPREHENDED. C/O DEPRESSION AND WANTING TO "ARTISTICALLY" EXPRESS HIMSELF BY THROWING THING! latlergy: Denied any known allergy. lHousing: Lives with parents in apartment [Financial Support: Current unemployed. Last worked earlier January. Stated he was working in Yorkdale Mail in the theater [Substance Use: Client denied any substance use. Medical Condition: Client denied any medical condition Continued on Ba’ This forms a part of the patient's medical recordage: 4 Fae: Hunbor River Hospital Loe:Witeon smergen: Bea:- 31M 20/11/1985 Med Rec Wum:H00104H022 VisserER153537/ Patient = ContLAued IPast Mental Health Histor) Ibehavior. jenied past history however he was seen by Dr. Salama in 2014 for similar |Family History of mental Health: Client denied any family history of mental Health [Psychosocial History: 33 year male who was presented to ED by the police after parents called for bizarre lbchavior. As per police, Parents stated client has acting strange, throwing dumbbell down from the balcony, leaaing neighbor's door, throwing water. Upset because dad was shaving, Stated father is “accepting of his belief". Client denied any medical history, any alleray, or any psychiatric problem. Stated he Is overwhelmed jwith life, Feels he is not progressing and in so much debt. Stated he dropped out school. Was studying lcoronary at Humber college. Client is the only child of the family, Parents are old and retired. Mental Status Examination: On mental status assessment, client was calm and cooperative. Stated he |was “inflamed” and constipated for the past 2 to 3 days. Stated when he feels toxics in his body he becomes "over inflamed. Could nat elaborate on what what he means by “inflamed”. Client endorsed feeling \depressed. Stated he is overwhelmed with life, not getting along with parents and not progressing In life jinstead going "backwards". Client stated he stopped going to work earlier in January 2014 because he could Inot handle it. Currently supported by the parents. Client denied any suicidal /homicidal ideation however, jpolice report stated client endorsed homicidal ideation, Stated he said “he wants to kill other". Client lacamantly denied such but stated "unless throwing egg and liquid can kill”. Police also stated that parents lhas been isolating himself and secluded toself. Not coming out and not engaging. Client remains calm, affect jis fiat end in stable mood, IRisk: Client denying suicidal ideation, at risk of hurting others by throwing things around. limpression: Client may be in prodromal stage. Further assessment may be required. Bizarre behavior. Lacks coping strategies dealing with stressful situations, IRecommendation: Suggested UTOX to rule out substance use/ induced psychosis. ARC's referral may be Ibeneficial ta help client connect. Ta be reassessed by the psychiatrist: Disposition: Client avraits EPU bed. Placed on Form 1 by the ED GP. Psychiatrist to assess. lit ized on 28/03/17 13:40 - END OF NOTE |28/03/17 13:10 Emergency Physician by Denissava,Daria Patient brought in by police. He building manager called them because the patlent was behaving laggressively. This morning, his father was shaving and that made the patient angry so he threw a dumbbell lout the windaw onto the street and just missed a car. Over the last 2 weeks the parents have naticed that ithe patient has been more sad but also at times aggressive and angry. They have been fearful for their own Isafety. He recently found that the neighbor downstairs is making too much noise and the door of his lapartments. The patient is complaining of insomnia and feeling “inflamed”. He is unable to explain what he Imeans by that. She denies drug alcohol and cigarette use. Previous medical history: Denies any medical or psychiatric history IMedications: No medications according to the patient, lPhysical exam: Patient is alert. He Is cooperative and calm. Eye contact is appropriate. Slightly flattened affect. Denies ued on Dai This forms a part of the patient's medical recordage: 5 jGHELE DOAN GIA Fae: Hunbor River Hospital Loe:Wileon smergonoy Bea:- 31M 20/11/1985 Med Rec Wum:H00104H022 visit: 2815333: Patient Notes ~ Continued Isuicical or homicidal ideation. Denies auditory or visual hallucinations. No signs of self-harm. \Good air entry bilaterally, heart sounds are unremarkable. lAbdomen is soft, no pain, no rebound. limpression and plan: Prodrome to schizophrenia? Given his aggressive and inappropriate behavior will put Ithe patient on form and have him assessed by psychiatry. \Vital Signs Temp | Pulse | Resp | BP Pulse Ox 28/03/17 12:44 | 36.4C| 61 | 19 | 97/63 | 97 28/03/17 11:43 | 36.6C| 61 | 16 | 108/71| 97 ** Electronically signed by Denissova, Daria, MD on 28/03/17 13:13 ** Hinitiaized on 28/03/17 13:10 - END OF NOTE VITAL SIGNS Temp] Pulse | Resp | BP Pulse Ox 29/03/17 12:44 | 36.4c| 61 19 | 97/63 | 97 29/03/17 11:43 | 36.6C| 61 | 16 | 108/71| 97 Clincal Data Rtn-NoAdd"1 bose patient have oxygen or IV? ther fsode of Transportation anbulatory Hnpatient for discharge within 24 hours? No fieiant feigne body Mass tndex (ner) lkeseon for VIP: [specific interventions to he provided Primary Diagnosis [secondary Diacnosis lpre-ope lnate of Sucgers [surgical Procedure: location lbp Return Date/Time Ibep Return Mins |rondition lcondition Comment Wisitors Allowed Wvseit Reason DEPRESSION-BIZZAPE BEKAVEOUR hanguace English Continued on Page © This forms a part of the patient's madical record.