Pediatric Agitation and Disruptive Behaviour

Question 1

Pediatric Agitation and Disruptive Behaviour - Initial actions? (3)

Answer 1

Consider backup and law enforcement
Attempt to diffuse the situation
BGL

Question 2

Pediatric Agitation and Disruptive Behaviour - Patient requires restraint? (3)

Answer 2

Restrain pt
Consider medical causes
Midazolam 0.1 mg/kg single max of 5mg IV or 0.2 mg/kg IM/IN

Question 3

Pediatric Agitation and Disruptive Behaviour - Agitated patient not requiring restraint? (3)

Answer 3

Consider medical causes
If acute anxiety Midazolam 0.2 mg/kg IM/IN single max of 10mg or Ativan 1 mg SL if > 20kg
Monitor SpO2 and ETCO2

Question 4

Pediatric Agitation and Disruptive Behaviour - Inadequate control 15 min post max dose of midazolam?

Answer 4

Haloperidol 0.05 mg/kg IM single max of 5 mg

Question 5

Pediatric Agitation and Disruptive Behaviour - GOT IVS Mnemonic for agitation?

Answer 5

Glucose
Oxygen, Overdose
Trauma, Temperature, Toxins
Infection - meningitis, tumor
Vascular - stroke, bleed
Seizure

Question 6

Pediatric Agitation and Disruptive Behaviour - Treatment priorities for cardiac arrest suspected in ExDs?

Answer 6

Sodium Bicarbonate 2 mEq/kg

NS 20 ml/kg

Question 7

Pediatric Agitation and Disruptive Behaviour - Midazolam indications

Answer 7

Sedation for acute anxiety or aggressive patients

Question 8

Pediatric Agitation and Disruptive Behaviour - Midazolam anxiety dose

Answer 8

midazolam 0.2mg/kg IM/IN max 10 mg

Question 9

Pediatric Agitation and Disruptive Behaviour - Midazolam contraindications

Answer 9

Hypersensitivity
Myasthenia gravis
Systolic BP less than 70 + (2 x age) mmHg

Question 10

Pediatric Agitation and Disruptive Behaviour - Midazolam aggressive patient dose

Answer 10

midazolam 0.1 mg/kg SIVP max 5 mg q 5 min prn to total 20 mg
midazolam 0.2mg/kg IM/IN q 15 min total max 20 mg

Question 11

Pediatric Agitation and Disruptive Behaviour - Haloperidol indication

Answer 11

Control of combative behaviour unresponsive to midazolam

Question 12

Pediatric Agitation and Disruptive Behaviour - Haloperidol dose

Answer 12

haloperidol 0.05 mg/kg IM max of 5 mg q 15 minutes prn total max 10 mg

Question 13

Pediatric Agitation and Disruptive Behaviour - Haloperidol contraindications

Answer 13

Hypersensitivity
CNS depression
Spastic disease
Parkinson’s syndrome
Comatose states
Seizure history

Question 14

Pediatric Agitation and Disruptive Behaviour - Lorazepam indication

Answer 14

Acute anxiety >20kg

Question 15

Pediatric Agitation and Disruptive Behaviour - Lorazepam dose

Answer 15

> 20kg 1 mg SL

Question 16

Pediatric Agitation and Disruptive Behaviour - lorazepam contraindications

Answer 16

Hypersensitivity to benzodiazepines

Acute narrow-angle glaucoma