Journal of the American College of Emergency Physicians open最新文献

{"title":"Image: Clubbing and hypoxia","authors":"Jerome B. Balbin MD,&nbsp;Jessica Carlo DO","doi":"10.1002/emp2.13291","DOIUrl":"https://doi.org/10.1002/emp2.13291","url":null,"abstract":"<p>A 40-year-old male with no significant past medical history presented to the emergency department with a severe headache for 3 days. On physical examination, the patient appeared very uncomfortable and was hypoxic on room air to 86%. He was ambulatory with no apparent focal neurologic deficits, but his fingers were clubbed. Electrocardiogram showed normal sinus rhythm. Computed tomography (CT) angiogram of the chest incidentally revealed a portosystemic shunt in the left upper quadrant. CT brain and magnetic resonance imaging (MRI) brain with and without contrast were obtained (Figures 1 and 2).</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13291","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An unusual acute erythrodermic rash","authors":"William Naworski MS,&nbsp;Andrew Shedd MD,&nbsp;Angela Shedd MD,&nbsp;Eric Chou MD","doi":"10.1002/emp2.13259","DOIUrl":"https://doi.org/10.1002/emp2.13259","url":null,"abstract":"<p>A 50-year-old woman with a history of mild atopic dermatitis presented to the emergency department (ED) for evaluation of a new rash slowly worsening over 3–4 weeks. She had erythematous patches and plaques with desquamating scale that together involved over 80% of her body surface area (Figure 1). It spared her palms, soles, and mucosa (Figures 2 and 3). She reported no new medications or exposures. Shortly after the rash started, topical ketoconazole and permethrin were prescribed without benefit. Basic lab tests were unremarkable except for mild leukocytosis. She was admitted for dermatologic consult and discharged with outpatient follow-up after a skin biopsy and initiation of topical erythrodermic protocol. The clinicopathologic correlation fit best with erythrodermic psoriasis. No triggers were identified, and her skin improved over the following month with standard psoriasis treatment.</p><p>A rare condition among those with psoriasis, erythrodermic psoriasis is the least common psoriatic subtype accounting for 3% of all psoriatic conditions. Common triggers include sunburn, alcohol, and infection. COVID-19 vaccination has also been reported as a possible trigger.<span>¹</span></p><p>Diagnosing erythrodermic psoriasis requires at least 75% body surface area involvement and biopsy findings of lymphocytic and eosinophilic perivascular infiltrates as well as dilated capillaries and hyperkeratosis.<span>²</span> The clinical differential diagnosis included staph scalded skin syndrome, as well as Steven Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) and Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS).</p><p>Cyclosporine and methotrexate are first-line pharmacologic treatment options for erythrodermic psoriasis, and the majority of patients achieve remission within 2–4 months.<span>³</span></p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13259","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142089789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A toddler with transient synovitis and COVID-19 infection","authors":"Teza Harrison BSA,&nbsp;Timothy Horezcko MD, MSCR,&nbsp;Marianne Gausche-Hill MD","doi":"10.1002/emp2.13250","DOIUrl":"https://doi.org/10.1002/emp2.13250","url":null,"abstract":"<p>Transient synovitis of the hip is a common medical emergency in children. Although reactive arthritis in adults may occur 1–4 weeks after COVID-19 infection or post-vaccination, few reports of transient synovitis in children associated with acute COVID-19 infection have been made. Transient synovitis of the hip occurs most frequently in children 3–8 years of age with a recent upper respiratory infection, bacterial infection, or trauma. This case report presents a unique case of an otherwise healthy 15-month-old girl with right hip pain and the refusal to ambulate associated with COVID-19 infection.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13250","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142077788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racing to disaster: A 10-year retrospective analysis of pediatric competitive motocross injuries","authors":"Erin B. Bruney MD,&nbsp;Kalei M. Rollins DO,&nbsp;Carolyn K. Holland MD, MEd,&nbsp;Robyn Hoelle MD,&nbsp;David Martin MD,&nbsp;Colleen K. Gutman MD,&nbsp;Tricia Swan MD","doi":"10.1002/emp2.13267","DOIUrl":"https://doi.org/10.1002/emp2.13267","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>In competitive motocross, children as young as 4 years old race in groups on motorized off-road bikes on uneven terrain. We aimed to describe pediatric injuries occurring during an annual week-long certified amateur motocross competition between 2011 and 2021. Secondarily, we compared injury characteristics and medical evaluation by age.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective analysis of injuries sustained by children during an annual motocross competition included children &lt;18 years who received care for an event-related injury within either of the two large regional hospital systems between 2011 and 2021. Data were collected through electronic health record review and analyzed with descriptive statistics. We used chi-square and Fisher exact tests to compare findings by age (young child less than 12 years vs. adolescent 12 years or older).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Over the 10-week study period (1 week per year for each of 10 years), 286 encounters were made by 278 children. Nearly all children (280/286, 98%) underwent imaging; most had at least one traumatic finding (71.7% of x-rays, 62.4% of computed tomography [CT] scans). Ninety-three children (32.5% of 286) sustained multisystem injuries. Emergency department procedures included one endotracheal intubation, one thoracostomy, 46 closed reductions, and 37 procedural sedations. Twenty-eight children (9.8% of 286) required operative intervention. Overall, 25.5% of children (73/286) were hospitalized and one adolescent died. Adolescents were more likely than young children to undergo CT imaging (40.1% vs. 26.8%, <i>p</i> = 0.042) and have multisystem injuries (36.3% vs. 23.2%, <i>p</i> = 0.045). There was no difference in hospitalization or operative intervention by age.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This comprehensive assessment of injuries sustained by children during competitive motocross demonstrates significant morbidity and mortality. Findings have implications for families who consider participation and health systems in regions where competitions occur.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13267","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142077791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between measures of resuscitation in the critical care resuscitation unit and in-hospital mortality among patients with sepsis","authors":"Nikki Emamian BS,&nbsp;Taylor Miller MD,&nbsp;Zoe Glick MD,&nbsp;Lauren Day MD,&nbsp;Lauren Becker MD,&nbsp;Aditi Singh BS,&nbsp;Tesia Shi,&nbsp;Jeffrey Rea MD,&nbsp;Kimberly Boswell MD,&nbsp;Quincy K. Tran MD, PhD","doi":"10.1002/emp2.13281","DOIUrl":"https://doi.org/10.1002/emp2.13281","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We hypothesized that lactate clearance and reduction of the Sequential Organ Failure Assessment (SOFA) score during patients’ critical care resuscitation unit (CCRU) stay would be associated with lower in-hospital mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective study of adult patients who had sepsis diagnoses and were admitted to the CCRU in 2018. Multivariable logistic regression analysis was performed to assess the association of clinical factors, lactate clearance, and SOFA reduction with hospital mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 401 patients with lactate clearance data and 455 patients with SOFA score data were included in the study. The mean (SD) lactate and SOFA score on admission were 2.2 (1.8) mmol/L and 4.4 (4.3), respectively. Average lactate clearance was 0.1 (2.6) mmol/L, and average SOFA score reduction was 0.65 (5.9). Patients with a one point reduction in SOFA score during their CCRU stay had a 31% reduction of mortality (odds ratio [OR] 0.69, 95% confidence interval [CI] 0.62–0.77, <i>p</i> &lt; 0.001). SOFA score reduction was associated with lower hospital mortality for both surgical patients (OR 0.69, 95% CI 0.58–0.81, <i>p</i> &lt; 0.001) and non-surgical patients (OR 0.71 95% CI 0.06–0.83, <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>SOFA score reduction, but not lactate clearance during the CCRU stay, was associated with lower odds of in-hospital mortality. These findings suggest that resuscitative efforts leading to an early improvement in SOFA score may benefit patients with sepsis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13281","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142077782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency department management of opioid use disorder in pediatric patients","authors":"Evan S. Schwarz MD,&nbsp;Ann M Dietrich MD,&nbsp;Stephen Sandelich MD,&nbsp;Gwen Hooley MD,&nbsp;Emily Rose MD,&nbsp;Tim Ruttan MD,&nbsp;Erin L. Simon DO,&nbsp;Carmen Sulton MD,&nbsp;Jessica Wall MD, MPH","doi":"10.1002/emp2.13265","DOIUrl":"https://doi.org/10.1002/emp2.13265","url":null,"abstract":"<p>Opioid use disorder (OUD) has emerged as a significant public health crisis affecting individuals across all age groups. However, there remains a critical gap in understanding the specific nuances and challenges associated with OUD in pediatric populations. This article provides a comprehensive review of the epidemiology, definition of OUD, screening recommendations for OUD, and evidence-based management strategies for OUD in pediatric patients.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13265","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142077793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wearable devices for out-of-hospital cardiac arrest: A population survey on the willingness to adhere","authors":"Saud Lingawi MEng,&nbsp;Jacob Hutton MSc,&nbsp;Mahsa Khalili PhD,&nbsp;Katie N. Dainty PhD,&nbsp;Brian Grunau MD,&nbsp;Babak Shadgan MD, PhD,&nbsp;Jim Christenson MD,&nbsp;Calvin Kuo PhD","doi":"10.1002/emp2.13268","DOIUrl":"https://doi.org/10.1002/emp2.13268","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>When an out-of-hospital cardiac arrest (OHCA) occurs, the first step in the chain of survival is detection. However, 75% of OHCAs are unwitnessed, representing the largest barrier to activating the chain of survival. Wearable devices have the potential to be “artificial bystanders,” detecting OHCA and alerting 9-1-1. We sought to understand factors impacting users’ willingness for continuous use of a wearable device through an online survey to inform future use of these systems for automated OHCA detection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were collected from October 2022 to June 2023 through voluntary response sampling. The survey investigated user convenience and perception of urgency to understand design preferences and willingness to adhere to continuous wearable use across different hypothetical risk levels. Associations between categorical variables and willingness were evaluated through nonparametric tests. Logistic models were fit to evaluate the association between continuous variables and willingness at different hypothetical risk levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The survey was completed by 359 participants. Participants preferred hand-based devices (wristbands: 87%, watches: 86%, rings: 62%) and prioritized comfort (94%), cost (83%), and size (72%). Participants were more willing to adhere at higher levels of hypothetical risk. At the baseline risk of 0.1%, older individuals with prior wearable use were most willing to adhere to continuous wearable use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Individuals were willing to continuously wear wearable devices for OHCA detection, especially at increased hypothetical risk of OHCA. Optimizing willingness is not just a matter of adjusting for user preferences, but also increasing perception of urgency through awareness and education about OHCA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13268","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142077792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceptions of the current and future emergency medicine workforce","authors":"Adriana Segura Olson MD, MAEd,&nbsp;Simiao Li-Sauerwine MD, MSCR,&nbsp;Aaron S. Kraut MD,&nbsp;William Burns MD,&nbsp;Kelly Williamson MD,&nbsp;Jeremy Branzetti MD, MHPE,&nbsp;Nicholas D. Hartman MD, MPH,&nbsp;Jonathan J. Oskvarek MD, MBA,&nbsp;Amer Aldeen MD,&nbsp;the Emergency Medicine Education Research Alliance (EMERA)","doi":"10.1002/emp2.13279","DOIUrl":"https://doi.org/10.1002/emp2.13279","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The objectives of the study were to assess emergency medicine (EM) physician perceptions of the EM job market 2 years after “The Emergency Medicine Physician Workforce: Projections for 2030” was published in <i>Annals of Emergency Medicine</i> and to examine how the workforce report may have influenced perceptions about job prospects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional survey was conducted in 2022 of EM residents, fellows, and attendings at 21 practice sites. Main outcomes were perceptions of the likelihood of currently finding any job, currently finding a desirable job, and confidence in the future EM job market.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Note that 831 of 1938 physicians (42.9%) responded. A total of 92.4% reported a high likelihood of finding any job currently, 49.8% reported a high likelihood of finding a desirable job currently, and 44.4% reported future confidence. Workforce report familiarity was associated with greater likelihood of finding a desirable job. Fellows were least confident in the future. Residents with desired Midwest location were twice as confident in the future job market; those with desired West location were less confident. Attendings 20 or more years post-training were more than twice as likely to report a high likelihood of finding a desirable job and almost twice as likely to report future confidence. Attendings in leadership were nearly three times as likely to report high a likelihood of finding a desirable job and future confidence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>EM trainees and attendings have favorable perceptions of the current job market but are less confident in future prospects. As the projected surplus of EM physicians appears to have had an impact, updated projections are needed for more accurate assessments of the future of the specialty.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13279","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142077781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Child presenting with unilateral vision loss","authors":"Allison Weisnicht MD,&nbsp;Eric Monroe MD","doi":"10.1002/emp2.13283","DOIUrl":"https://doi.org/10.1002/emp2.13283","url":null,"abstract":"<p>A previously healthy 3-year-old girl child presented to the emergency department for progressive ataxia and left iris discoloration (Figure 1A). Examination revealed a dilated, non-reactive left pupil, leukocoria, and decreased visual acuity. A dilated fundus examination revealed a large inferior white tumor, exudative retinal detachment, and vitreous seeding consistent with Group E retinoblastoma. Magnetic resonance imaging confirmed a left retinal mass with hemorrhagic retinal detachment. Due to localized disease, the patient was a candidate for intra-arterial chemotherapy (IAC). Triple drug IAC was initiated. With her third cycle of IAC, she had improvement in pupillary dilatation, reactivity, and resolving heterochromia iridium (Figure 1B).</p><p>Heterochromia iridium is often benign and congenital; however, new onset heterochromia should raise suspicion for a sinister underlying process. Retinoblastoma, the most common intraocular malignancy of childhood, typically presents with leukocoria or strabismus, while heterochromia iridium is observed in less than 2% of cases. Potential mechanisms causing heterochromia iridium include siderosis secondary to hemorrhagic retinal detachment as was present in this case.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13283","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142045271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategies for optimal management of pediatric acute agitation in emergency settings","authors":"Mohsen Saidinejad MD, MBA,&nbsp;Ashley A. Foster MD,&nbsp;Genevieve Santillanes MD,&nbsp;Joyce Li MD, MPH,&nbsp;Dina Wallin MD,&nbsp;Isabel A. Barata MD, MBA,&nbsp;Madeline Joseph MD,&nbsp;Emily Rose MD,&nbsp;Tabitha Cheng MD,&nbsp;Muhammad Waseem MD, MS,&nbsp;Kathleen Berg MD,&nbsp;Gwendolyn Hooley MD,&nbsp;Timothy Ruttan MD,&nbsp;Sam Shahid MBBS, MPH,&nbsp;Samuel H. F. Lam MD, MPH,&nbsp;Siraj Amanullah MD,&nbsp;Sophia Lin MD,&nbsp;Melanie S. Heniff MD, MHA,&nbsp;Kathleen Brown MD,&nbsp;Marianne Gausche-Hill MD,&nbsp;ACEP Pediatric Emergency Medicine Committee","doi":"10.1002/emp2.13255","DOIUrl":"https://doi.org/10.1002/emp2.13255","url":null,"abstract":"<p>Acute agitation in youth is a challenging presentation to the emergency department. In many cases, however, youth can be behaviorally de-escalated using a combination of environmental modification and verbal de-escalation. In cases where additional strategies such as pharmacologic de-escalation or physical restraint are needed, using the least restrictive means possible, including the youth in the decision-making process, and providing options are important. This paper reviews specific considerations on the approach to a youth with acute agitation and strategies and techniques to successfully de-escalate agitated youth who pose a danger to themselves and/or others.</p>","PeriodicalId":73967,"journal":{"name":"Journal of the American College of Emergency Physicians open","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/emp2.13255","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142045270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}