Pediatric emergency medicine trisk 4170 4170
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antipsychotics, for the prevention of EPS. Others prefer to use these
medications only if and when EPS develop.
NMS is a rare complication of antipsychotic use. It is more commonly
seen in young, muscular males, although it may occur in patients of any age,
gender, and body habitus. Pre-existing dehydration and chronic
antipsychotic use are other risk factors for developing NMS. Because there
is no test that absolutely confirms it, NMS can be vexing to diagnose. In
addition, the clinical picture of fever, altered mental status, and autonomic
hyperactivity may be difficult to differentiate from meningoencephalitis,
intracranial injury, various toxins, serotonin syndrome, or an underlying
psychiatric condition. It should be strongly considered in any agitated patient
whose condition worsens or does not resolve when given antipsychotic
medication.
Of note, two antipsychotics, thioridazine and droperidol, currently carry
FDA “black box” warnings as they may cause fatal arrhythmias.
Physical Restraint. Any device that restricts a patient’s mobility is a physical
restraint. Theoretically, a bed rail is a form of restraint. In the treatment of
agitated patients, however, physical restraints specifically refer to devices
used with the express purpose of restraining a patient’s limbs. Only such
approved devices should be used for physical restraint.
