Chemical restraints for the agitated, violent, or psychotic pediatric patient in the emergency department: Controversies and recommendations

Current Opinion in Pediatrics

Volumn 16, Issue 2, 2004, Pages 201-205

  Sorrentino, Annalise ^a  

^a UNIVERSITY OF ALABAMA SCHOOL OF MEDICINE   (United States)

Author keywords

Chemical restraint; Emergency department; Pediatrics

Indexed keywords

ALCOHOL; ALPRAZOLAM; AMIODARONE; ANTIARRHYTHMIC AGENT; ANTIBIOTIC AGENT; ANTIEMETIC AGENT; ANTIFUNGAL AGENT; ANTIHISTAMINIC AGENT; ATYPICAL ANTIPSYCHOTIC AGENT; BENZATROPINE; BENZODIAZEPINE DERIVATIVE; CHLORPROMAZINE; DANTROLENE; DECONGESTIVE AGENT; DIAZEPAM; DIPHENHYDRAMINE; DROPERIDOL; FLECAINIDE; HALOPERIDOL; IBUTILIDE; LORAZEPAM; LOXAPINE; MIDAZOLAM; NEUROLEPTIC AGENT; OLANZAPINE; PROCAINAMIDE; QUINIDINE; SOTALOL; UNINDEXED DRUG; ZIPRASIDONE;

AGGRESSION; AGITATION; ALCOHOL INTOXICATION; ANTICHOLINERGIC EFFECT; ANXIETY; ATAXIA; AUTONOMIC DYSFUNCTION; CLINICAL PRACTICE; CONFUSION; COST EFFECTIVENESS ANALYSIS; DIFFERENTIAL DIAGNOSIS; DISEASE EXACERBATION; DIZZINESS; DRUG CONTRAINDICATION; DRUG EFFECT; DRUG EFFICACY; DRUG INDICATION; DRUG INTOXICATION; DRUG POTENCY; DRUG SAFETY; DRUG TOLERABILITY; DRUG USE; DYSTONIA; EMERGENCY WARD; EVALUATION; EXTRAPYRAMIDAL SYMPTOM; EYE DISEASE; HEADACHE; HEALTH CARE PERSONNEL; HEART ARRHYTHMIA; HUMAN; HYPERTENSION; HYPERTHERMIA; HYPOTENSION; IMMOBILIZATION; MEDICAL DECISION MAKING; MENTAL DISEASE; MUSCLE RIGIDITY; NAUSEA; NEUROLEPTIC MALIGNANT SYNDROME; OCULAR CRISIS; OPISTHOTONUS; ORTHOSTATIC HYPERTENSION; PATIENT; PATIENT CARE; PATIENT MONITORING; PRIORITY JOURNAL; PSYCHOSIS; QT PROLONGATION; RESPIRATION DEPRESSION; RESPIRATORY TRACT DISEASE; REVIEW; SAFETY; SEDATION; SEIZURE; TORTICOLLIS; TREATMENT INDICATION; VIOLENCE;

ADOLESCENT; ANTIPSYCHOTIC AGENTS; BENZODIAZEPINES; CHILD; CHILD BEHAVIOR DISORDERS; EMERGENCIES; HUMANS; PSYCHOMOTOR AGITATION; PSYCHOTIC DISORDERS; VIOLENCE;

EID: 1642282825     PISSN: 10408703     EISSN: None     Source Type: Journal    
DOI: 10.1097/00008480-200404000-00016     Document Type: Review

References (20)

1. Weiss EM: Deadly Restraint: A Hartford Courant Investigative Report. The Hartford Courant; October 11, 1998.
2. Zun LS: A prospective study of the complication rate of use of patient restraint in the emergency department. J Emerg Med 2003, 24:119-124. This article illustrates that restraining patients is not without its own risks.
3. Committee on Pediatric Emergency Medicine: The use of physical restraint interventions for children and adolescents in the acute care setting. Pediatrics 1997, 99:497-498.
4. Richards CF, Gurr DE: Psychiatric Emergencies: Psychosis. Emerg Med Clin North Am 2000, 18:253-262.
5. Dorfman DH: The use of physical and chemical restraints in the pediatric emergency department. Pediatr Emerg Care 2000, 16:355-360.
6. Gross G: Restraint and seclusion-overview of federal laws and policies. Available at: http://www.napas.org. Accessed September 22, 2003.
7. Masters KJ: Practice parameter for the prevention and management of aggressive behavior in child and adolescent psychiatric institutions, with special reference to seclusion and restraint. J Am Acad Child Adoles Psych 2002, 41:4S-25S. This paper outlines a practice parameter for the agitated child and adolescent, with special reference to restraint.
8. Kao LW, Moore GP, Jackimczyk KC: The combative patient: chemical restraints. In Marx: Rosen's Emergency Medicine: Concepts and Clinical Practice, 5th ed. Edited by Marx J, Hockberger RS, Walls RM, et al. St. Louis: Mosby; 2002:2595-2599.
9. Bates B: Few psychotropics have data for use in children. Pediatric News 1999, 33:27.
10. Citrone L: Atypical antipsychotics for acute agitation. Postgrad Med 2002, 112:85-96. This article gives a good overview of older medications, as well as the newer ones on the market. Although directed toward adult patients, it still gives a good idea of what's on the horizon.
11. Erb JL: Assessment and management of the violent patient. In Jacobson: Psychiatric Secrets, 2nd ed. Edited by Jacobson JL, Jacobson AM. Philadelphia: Hanley and Belfus; 2001:441-446.
12. Wigder HN: Restraints. Emedicine 2002. Available at: http://www. emedicine.com. Accessed September 25, 2003.
13. Woosley RL: Drugs that prolong the QT interval and/or induce torsades de pointes. Available at: http://www.qtdrugs.org. Accessed October 2, 2003.
14. Chase PB, Biros MH: A retrospective review of the use and safety of droperia large, high-risk, inner-city emergency department patient population. Academic Emergency Medicine 2002, 9:1402-1410. A good retrospective review that demonstrates few adverse events in patients re-ceiving droperidol in the emergency department.
15. Kao LW, Kirk MA, Evers SJ, Rosenfeld SH: Droperidol, QT prolongation, and sudden death: What is the evidence? Ann Emerg Med 2003, 41:546-558. A thorough literature search questioning a causal relation between droperidol use and sudden cardiac death.
16. Dershwitz M: Droperidol: should the black box be light gray? Journal of Clinical Anesthesiology 2002, 14:561-563.
17. Battaglia J, Moss S, Rush J, et al.: Haloperidol, lorazepam, or both for psychotic agitation? A multicenter, prospective, double-blind, emergency department study. Am J Emerg Med 1997, 15:335-340.
18. Hill S, Petit J: Psychiatric Emergencies: The Violent Patient. Emerg Med Clin North Am 2000, 18:301-315.
19. Bieniek SA, Ownby RL, Penalver A, Dominguez RA: A double-blind study of lorazepam versus the combination of haloperidol and lorazepam in managing agitation. Pharmacotherapy 1998, 18:57-62.
20. Torrey EF: Severe psychiatric disorders may be increasing. Psychiatric Times 2002:19.