Pediatric emergency medicine trisk 4172 4172
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (70.52 KB, 1 trang )
the patient by the ordering physician within 1 hour of the patient being
placed in restraints. Orders for restraint can be renewed, but each order
cannot exceed 1 hour for children younger than 9 years, 2 hours for children
and adolescents between 9 and 17 years, or 4 hours for adults.
Restraints should be removed as soon as possible in an organized manner,
taking into account the severity of the patient’s agitation. The same number
of personnel needed to place the restraints should be present when the
restraints are removed, in case the restraints need to be reapplied. There is no
consensus as to the optimal method; some remove all restraints once the
patient is judged to be safe. Others prefer a stepwise approach, releasing an
arm first, then the opposite leg, and finally the remaining limbs. Between
each step, the patient is informed that if they remain under control, the
removal process will continue. Patients should not be left with only one limb
restrained. They have too much mobility and could injure themselves or
others if they become combative.
Disposition
Patients who are at imminent risk of serious harm to others and who cannot
be safely maintained in lower levels of care require admission to an inpatient
psychiatric facility. Alternatives to inpatient admission include partial
hospitalization programs, acute residential treatment, in-home services,
routine outpatient care, and, in rare circumstances, placement in the juvenile
justice system. Outpatient and in-home services may be of particular use
when family issues are playing a significant role in the unsafe behaviors.
Brief placements in respite care or alternative placements for those in foster
care may also be considered as a diversion from inpatient hospitalization.
Special efforts should be made to avoid inpatient hospitalization in very
young children, children with reactive-attachment disorders, or those with
personality disorders; for these populations in particular, admission may be
countertherapeutic.
Caregivers of those being discharged home should be counseled regarding
means restriction of potential weapons, provided with de-escalation
strategies, and instructed on indications for return. ED physicians may also
use this opportunity to help parents establish, present, and/or reinforce any
pertinent behavioral rules, rewards, consequences, etc. for the child.
