BEHAVIOURAL EMERGENCIES

Question 1

Approach to Acute Aggitation

Answer 1

Ensure personal safety & Safety of Staff

Four Point Restraint

Lorazepam: 0.05 - 0.1 mg / kg (max 4 mg) IM / IV

Midazolam: 0.2 mg / kg IN

Olanzapine:
Child 5 mg PO / Dissolving Tablet
Adolescent 10 mg PO / Dissolving Tablet

Haloperidol:
0.025 - 0.075 mg / kg / dose PO / IM / IV
Child 1 mg
Adolescent 5 mg

Risperidone:
Child 0.5 mg PO / dissolving tablet
Adolescent 1 mg PO

Question 2

History & Physical

Answer 2

Assess child and caregiver apart

Ask About:

Chief Complaint
Get collateral history

Screen For:

Mood
Anxiety
Substance Use
Psychotic Features
Suicide
Homicide

HEADSSS exam
Home Stressors
Bullying
Peer Related Issues

Trauma
Non-accidental Trauma
Infectious Symptoms
Drug Ingestion
Medical Issues

Question 3

DDx

Answer 3

Mood Disorder
Substance Use Disorder / Toxidrome
Child Abuse
ADHD
Autism
Oppositional Defiant Disorder
Conduct Disorder
Learning Disability