Start with adolescent suicide assessment, then read tear gas exposure and tyrosine deficiency for three cases where one reassuring sign can mislead.
Passive suicidal thoughts still need intent, plan and means checked.
Start with the adolescent suicide prevention episode. It gives a usable structure for a high-stakes consultation: private time with the adolescent, direct questions about self-injury, suicidal thoughts, intent, plan, past behaviour, access to lethal means, protective factors, then a collaborative safety plan with caregivers and clear escalation pathways. That is the clearest practice change in today’s set.
This is otherwise a mixed briefing, but several episodes warn against stopping at the first reassuring finding. Passive thoughts of death still need method, intent and planning explored. A child with severe motor delay, hypotonia, fluctuating dystonia, or oculogyric crises can still have a treatable dopamine biosynthesis disorder despite a normal MRI. After tear gas or pepper spray exposure, normal early oxygen saturation does not exclude airway distress, bronchospasm, or evolving pulmonary oedema. The rest of the page covers ED flow, shame in surgical training, and early migraine trial data.
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Start here if adolescent self-harm or hopelessness appears anywhere in your practice. The episode gives a usable structure for asking directly about non-suicidal self-injury, suicidal thoughts, intent, plan, past behaviour, protective factors, and access to lethal means, then building a realistic safety plan.
Tear gas exposure is easy to underestimate when symptoms look transient. This episode is worth opening for the reminder that eye pain, wheeze, skin burns, corneal injury, blunt trauma, and evolving pulmonary oedema can sit in the same presentation, with decontamination and early escalation doing the work.
ED efficiency here means getting the right patient to the right next step at the right time, not moving faster for its own sake. The practical gain is the shift-start scan, the focused chart biopsy, and front-loading physician-dependent tasks before flow stalls.
Severe motor delay with hypotonia, fluctuating dystonia, oculogyric crises, and a normal MRI should prompt a look at tyrosine hydroxylase deficiency. Niche, but worth keeping in mind because the disorder is treatable and early dyskinesia on L-dopa is not a reason to stop.
Humiliating feedback is separated clearly from firm correction of unsafe care. The useful point is not wellness language but teaching behaviour: name the safety issue, keep the trainee’s character out of it, and notice how shame, burnout, isolation, and suicidal thoughts can follow.
Internalised shame matters even when nobody has openly humiliated the trainee. This follow-on episode is best opened after the earlier shame discussion, because it shows how self-blame after criticism or complications links with burnout and why mentorship and debriefing matter.
New migraine drugs often generate excitement before the evidence is ready. This update stays grounded: phase 2 data show dose-responsive gains in pain and associated symptoms, but paraesthesias and feeling warm increase with dose, and routine use still waits for confirmatory trials.
Give adolescents private time before the rest of the history. After a positive screen, ask directly about current thoughts, method, intent, plan, past behaviour, protective factors, and access to lethal means, then build a safety plan with coping steps and named adults who can actually help.
How do I tell non-suicidal self-injury from suicidal behaviour?
Clarify intent to die. Non-suicidal self-injury usually serves emotion regulation, control, or relief from distress, but it still matters because earlier onset and longer duration increase later suicide attempt risk.
What must I ask after passive suicidal ideation is disclosed?
Do not stop at “better off dead” thoughts. Explore current thoughts, method, intent, plan, past behaviour, protective factors, and access to lethal means.
What makes tear gas exposure more than a simple eye-wash case?
Wheeze, chest tightness, reduced vision, significant burns, persistent symptoms, or suspected head injury from a projectile should push early escalation. Contact lenses can also trap the agent and prolong eye injury.
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