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Violence, Management of, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • EDs and waiting rooms are areas of high prevalence for violence

  • Higher risk associated with busier EDs

  • Patients with primary psychiatric complaints are likely to be boarding >24 hr ...

Diagnosis

Signs and Symptoms

  • Early signs of impending violence risk (nonspecific):

    • Loud speech

    • Physical agitation or tension (pacing, clenching fists, darting eyes)

  • Later signs of impending violence risk:

    • ...

Treatment

  • Medical workup is important, but in an emergency you may need to restrain potentially violent patients 1st to reduce risk of harm to self or others

  • Involve security or police as needed

Pre-Hospital

Follow-Up

Disposition

Admission Criteria

  • Medical admission for medical conditions not temporary or reversible in the ED

  • Medical admission if further medical workup needed for which ED setting is not opti...

Pearls and Pitfalls

  • Do not assume that patients with violent behavior have only psychiatric problems

  • Patients who have been restrained require appropriate monitoring, including regular nursing checks a...

Additional Reading

  • Coburn  VA, Mycyk  MB. Physical and chemical restraints. Emerg Med Clin North Am.  2009;27:655–667.

  • Lukens  TW, Wolf  SJ, Edlow  JA, et al. Clinical policy: Critical issues in t...

Codes

ICD9

  • 292.89 Other specified drug-induced mental disorders

  • 312.9 Unspecified disturbance of conduct

  • 312.30 Impulse control disorder, unspecified

  • 298.9 Unspecified psychosis

ICD10

  • F19.929 Oth psychoacti...

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