Sedating agitated child ppt
Behavioral intervention (eg, verbal de-escalation, seclusion) should be the initial approach for management of agitated patients, but when these techniques are ineffective, pharmacologic treatment becomes necessary. This article reviews the clinical challenges in managing agitation in the emergency setting. • Agitation demands rapid treatment that frequently precludes a thorough evaluation of etiology, therefore requiring rapidly acting treatments that are effective and safe. • While nonpharmacologic intervention should be attempted whenever possible, medication may be administered voluntarily or under duress, with the aim of safely and swiftly making the patient less agitated and hostile.
Currently available pharmacologic treatments for agitation do not fulfill all of these criteria, and there are significant unmet needs for novel antiagitation treatments that are rapid in onset, accepted by patients and staff, less invasive (as compared with intramuscular or intravenous formulations), and easy and safe to administer. Social and neural determinants of aggressive behavior: pharmacotherapeutic targets at serotonin, dopamine and gamma-aminobutyric acid systems.
Patient characteristics that increase the probability of a non-psychiatric cause of agitation include lack of prior psychiatric history, older age, and new or pre-existing medical complaints.
It has been suggested that a brief medical work-up be carried out in patients without a psychiatric history, with features not consistent with a psychiatric diagnosis (eg, lethargy, confusion), with abnormal vital signs, with sudden onset of agitation, and who are known to have recently started any new medications (eg, anticholinergics, steroids).
The etiology of agitation for the patient in the emergency department may be unknown, while some patient history is likely to be available to personnel in the psychiatric clinic.
Treatment selection may be more difficult in the emergency department versus the psychiatric clinic because healthcare professionals in the psychiatric clinic may have more information about efficacy of prior treatments in a given patient. Violence in the emergency department: a survey of health care workers.