Pediatric emergency medicine trisk 4163 4163
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should allow patients to feel some control over their current
situation. Creating a space where the child feels safe, giving them
choices when possible, and actively listening may improve care. It
helps providers maintain compassion when dealing with children
that, on the surface, seem challenging or antagonistic. Implementing
such care usually requires careful negotiations with patient, as well
as planning and flexibility by ED clinicians.
Clinical Considerations
Clinical Recognition
Agitation may manifest in a wide variety of behaviors, depending on the
patient’s age and developmental and physical state. Signs and symptoms
may include restlessness, hyperactive motor activity, confusion or
disorientation, uncontrollable crying, verbal threats, and overt physical
violence toward oneself, others, or physical property.
Triage
A patient who is mildly agitated or who presents for evaluation of threats of
harm may be able to wait safely in an ED waiting room and may benefit
from de-escalating strategies. However, care should be taken to monitor
these patients for signs of escalation and to prevent elopement. A thorough
search of persons and belongings should be performed.
Actively/potentially violent or highly agitated patients require immediate
transition to a secure area of the ED that is under the constant observation of
hospital personnel. Security staff should be used whenever patients have the
potential for significant violence or aggression.
