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  • Print publication year: 2013
  • Online publication date: April 2013

Chapter 29 - Pediatric psychiatric disorders in the emergency department

from Section 5. - Special populations


Emergency physicians are frequently required to care for unknown patients with acute undifferentiated agitation. Agitation is known to be associated with several other psychiatric and medical causes. Agitation, regardless of the etiology, is a behavioral emergency. Both typical (first-generation) and atypical (second-generation) antipsychotics are frequently used in the management of agitation. Several of the typical antipsychotics have been associated with QT prolongation and torsades de pointes. Other acute adverse effects of antipsychotic use in the treatment of acute agitation include anticholinergic effects, movement disorders, and neuroleptic malignant syndrome. Benzodiazepines are commonly used in the acute management of agitation. In addition to rapid sedation, ketamine's short duration of action, parenteral administration, and in particular the preservation of protective airway reflexes, are attractive properties in the management of patients with acute agitation. According to the Joint Commission Standards, restraints can only be used when clinically justified or when warranted by patient behavior.


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