Pediatric emergency medicine trisk 4165 4165
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Assessment and frequent reassessment signs and symptoms for violence
and danger to others are important ( Tables 126.5 and 126.6 ). Patients
should be asked if they currently have any violent or homicidal thoughts, if
they have specific plans or thoughts, if they have access to firearms or other
weapons. Unfortunately, no single sign, symptom, or set of criteria
successfully identifies all patients with significant risks for violence.
Management
Verbal De-Escalation. Studies have shown that when hospital staff are
trained in verbal de-escalation techniques, there is significant decrease in the
use of medications and physical restraint in the care of psychiatric patients.
Ideally, all ED staff participating in the care of psychiatric patients should
have training in verbal de-escalation techniques ( Table 126.7 ).
All verbal de-escalation techniques share common features. Strategies
include approaching the patient with a calm, nonjudgmental manner, and
being empathetic. The simple act of listening can have a powerful effect.
The patient should be reassured that the ED staff is there to help and work
with them. Frequent updates about the care plan can help the patient stay
calm.
