Assessing Agitation in Patients

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Questions and Answers

What is the primary concern for patient and clinician safety in moderate symptoms of agitation?

Patient is irrational and exhibiting behavior that puts themselves or clinicians at risk (correct)

Patient is physically violent and presents an immediate and imminent threat to themselves or others

Patient is calm and relaxed

Patient is cooperative and making rational decisions

What is the first step in managing a patient with mild agitation?

Request law enforcement assistance

Assess patient's capacity and risk for self-harm

Attempt verbal de-escalation and provide emotional support (correct)

Place the patient in a supine position

What is the goal of the SAFER Model in managing agitation?

To provide emotional support and facilitate resources (correct)

To sedate the patient

To call for law enforcement backup

To restrain the patient

In what position should the patient be placed as soon as practical in managing agitation?

Supine position (face up) Signup and view all the answers

What is the primary responsibility of the clinician in managing agitation?

To maintain scene safety and have a low threshold for requesting law enforcement Signup and view all the answers

What is the key difference between mild and moderate symptoms of agitation?

Presence of immediate concern for patient or clinician safety Signup and view all the answers

What is the purpose of the SAFER Model's 'Recovery or Referral' stage?

To release the patient into the care of a responsible person or professional Signup and view all the answers

Why is it important to consider causes of agitation in managing the patient?

To identify underlying medical or psychiatric conditions Signup and view all the answers

What is the first step in attempting verbal de-escalation and providing emotional support in a patient with mild agitation?

Stabilize the situation by containing and lowering the stimuli. Signup and view all the answers

What is the dose of epinephrine auto-injector for a patient with mild allergic reaction and a history of life-threatening allergic reaction to the same allergen, who is less than 5 years of age?

0.15 mg IM Signup and view all the answers

What should be done after administering epinephrine auto-injector for a patient with mild allergic reaction?

Repeat the dose one time, as needed, within 30 minutes. Signup and view all the answers

What is the concentration of epinephrine that is appropriate for the IM route only?

1 mg/mL Signup and view all the answers

What is the indication for administering epinephrine auto-injector for a patient with mild allergic reaction?

Localized swelling and itching at the site. Signup and view all the answers

What should be done for a patient with moderate allergic reaction who is less than 2 years of age?

Administer nebulized albuterol (BLS) 1.25 mg. Signup and view all the answers

What is the route of administration for epinephrine auto-injector?

IM Signup and view all the answers

What is the next step after assessing and acknowledging the crisis in a patient with mild agitation?

Stabilize the situation by containing and lowering the stimuli. Signup and view all the answers

What is the dose of albuterol (BLS) nebulizer for a patient with moderate allergic reaction who is 2 years of age or greater?

2.5 mg Signup and view all the answers

What should be done if additional doses of epinephrine auto-injector, epinephrine, albuterol, ipratropium, diphenhydramine are needed beyond those listed?

Consult with a medical professional. Signup and view all the answers

What is the appropriate concentration of epinephrine for the IM route?

1 mg/mL Signup and view all the answers

When should epinephrine be given by the IV route?

For patients in anaphylaxis or cardiac arrest Signup and view all the answers

What is a key component of the Pediatric Assessment Triangle?

Skin color change Signup and view all the answers

What is the primary reason for transporting ALTE/BRUE patients?

To identify underlying illnesses or injuries Signup and view all the answers

What is the indications for HYPOglycemia/HYPERglycemia in pediatric patients?

Blood glucose less than 70 mg/dL or greater than 300 mg/dL Signup and view all the answers

How much oral glucose should be administered to a pediatric patient with HYPOglycemia?

10-15 grams Signup and view all the answers

What is an indication for Hyperkalemia in adult patients?

Renal failure or chronic kidney disease Signup and view all the answers

What is the primary goal when managing Hyperkalemia in adult patients?

Placing the patient in a position of comfort Signup and view all the answers

What is a key consideration when transporting an ALTE/BRUE patient?

Consulting with a Pediatric Base Station physician Signup and view all the answers

What is a crucial aspect of HYPOglycemia/HYPERglycemia management in adult patients?

Checking blood glucose levels Signup and view all the answers

What is the recommended dose of Acetaminophen for a 4-year-old child with mild to moderate pain?

One unit dose of 160 mg/5 mL Signup and view all the answers

What is the maximum dose of Acetaminophen recommended for a 13-year-old child with mild to moderate pain?

650 mg Signup and view all the answers

What is the primary reason for transporting a patient to the hospital after administering pain medication?

To receive a comprehensive evaluation of the cause of their pain Signup and view all the answers

What type of pain is Ketamine indicated for?

Musculoskeletal and back pain Signup and view all the answers

What is the primary indication for anaphylaxis in an adult?

Acute onset of severe illness after exposure to a known allergen with two or more of the following: urticaria, respiratory compromise, hypotension, or GI symptoms Signup and view all the answers

What is the recommended form of Acetaminophen for a 13-year-old child with mild to moderate pain?

One 325 mg pill or tablet Signup and view all the answers

What is the recommended dose of Acetaminophen for a 5-year-old child with mild to moderate pain?

Two unit doses of 160 mg/5 mL each Signup and view all the answers

What is the recommended dose of epinephrine for an adult with anaphylaxis?

0.3 mg IM in the lateral thigh Signup and view all the answers

What is the recommended dose of epinephrine for a pediatric patient under 5 years of age with anaphylaxis?

0.15 mg IM in the lateral thigh Signup and view all the answers

What is the recommended treatment for an adult with anaphylaxis and wheezing/bronchospasm/shortness of breath?

Albuterol 2.5 mg nebulized Signup and view all the answers

What is the recommended route of administration for epinephrine in anaphylaxis?

Intramuscular (IM) route Signup and view all the answers

What is the recommended dose of albuterol for a pediatric patient under 2 years of age with anaphylaxis and wheezing/bronchospasm/shortness of breath?

Albuterol 1.25 mg nebulized Signup and view all the answers

What is the indication for considering pediatric epinephrine infusion for refractory anaphylactic shock?

Blood pressure goals not met upon reaching epinephrine infusion rate of 2 mL/min Signup and view all the answers

What is the recommended treatment for an adult with anaphylaxis and hypotension?

Epinephrine 1 mg/mL IM Signup and view all the answers

What is the indication for administering albuterol in anaphylaxis?

Wheezing/bronchospasm/shortness of breath Signup and view all the answers

What is the recommended action if blood pressure goals are not met upon reaching epinephrine infusion rate of 2 mL/min?

Obtain medical consultation Signup and view all the answers

What is the primary indication for considering hyperkalemia in a patient?

Renal failure or chronic kidney disease Signup and view all the answers

What is the recommended position for a patient experiencing nausea or vomiting?

Left lateral position Signup and view all the answers

What is the primary consideration when assessing a patient's pain level?

The patient's self-reported pain level Signup and view all the answers

What is the recommended dosage of acetaminophen for mild to moderate pain?

650 mg with sips of water as tolerated Signup and view all the answers

What is the purpose of the FACES scale in pain assessment?

To help patients rate their pain level Signup and view all the answers

What is the primary indication for considering hyperkalemia in a pediatric patient?

Renal failure or chronic kidney disease Signup and view all the answers

What is the recommended treatment for nausea or vomiting in a patient with a high risk for aspiration?

Left lateral position Signup and view all the answers

What is the primary goal of pain management in a patient with a painful condition?

To reduce the pain to a manageable level Signup and view all the answers

What is the recommended action for a patient with mild to moderate pain?

Allow the patient to remain in a position of comfort Signup and view all the answers

What is the primary consideration when assessing a patient's pain level using the pain rating scale?

The patient's self-reported pain level Signup and view all the answers

What is the primary indication for administering ketamine in pain management?

Musculoskeletal and back pain Signup and view all the answers

What should be initially administered to a patient with chest pain suspected to be due to acute coronary syndrome?

Nitroglycerin Signup and view all the answers

What is the concern when using opioid analgesia in patients with suspected exacerbation of congestive heart failure?

Worsening of heart failure Signup and view all the answers

What should be observed for when using analgesia in patients with altered mental status?

Respiratory depression Signup and view all the answers

What is the requirement for transporting a patient who has received a parenteral dose of opioid, benzodiazepine, or ketamine?

ALS transport if the patient has received any of these medications within the past 1 hour or has an altered mental status Signup and view all the answers

What is the rating scale used to measure pain in younger children?

FACES scale Signup and view all the answers

What is the pain rating for 'Miserable/Distressing' on the Pain Rating Scale?

6 Signup and view all the answers

What is the primary goal when managing pain in patients?

Relieve pain and discomfort Signup and view all the answers

What is the recommendation for patient positioning in managing pain?

Allow the patient to remain in a position of comfort Signup and view all the answers

What is the pain rating for 'No pain' on the Pain Rating Scale?

0 Signup and view all the answers

Study Notes

Agitation

Indications:
- Mild symptoms: patient is agitated but cooperative and making rational decisions, with no immediate concern for patient or clinician safety
- Moderate symptoms: patient is irrational and exhibiting behavior that puts themselves or clinicians at risk
- Severe symptoms: patient is physically violent and presents an immediate and imminent threat to themselves or others
BLS (Basic Life Support) interventions:
- Maintain scene safety and have a low threshold for requesting law enforcement
- Assess patient's capacity and risk for self-harm
- Place the patient in a supine position (face up) as soon as practical
- Consider causes of agitation (medical, head trauma, psychiatric, drug/alcohol ingestion)
- Attempt verbal de-escalation and provide emotional support using the SAFER Model

Allergic Reaction

Indications:
- Mild symptoms: localized swelling and itching at the site
- Moderate symptoms: hives and/or mild wheezing
- Severe symptoms: diffuse wheezing, pharyngeal swelling, dyspnea, hypoperfusion, abnormal skin color, stridor, and/or loss of peripheral pulses
BLS interventions:
- Adult:
  - Epinephrine auto-injector (0.3 mg IM) or epinephrine (0.5 mg IM)
  - Albuterol inhaler (2 puffs) or nebulized albuterol (2.5 mg)
- Pediatric:
  - Less than 5 years: pediatric epinephrine auto-injector (0.15 mg IM) or epinephrine (0.15 mg IM)
  - 5 years or older: epinephrine auto-injector (0.3 mg IM) or epinephrine (0.5 mg IM)
  - Albuterol inhaler (2 puffs) or nebulized albuterol (1.25 mg or 2.5 mg depending on age)

Altered Mental Status

Check pulse, vital signs, and perform physical exam
Assess for signs of trauma, fever, and blood glucose levels
Consider differential diagnoses: hypo/hyperglycemia, seizures, stroke, cardiac arrest, and others
BLS interventions: based on underlying cause of altered mental status

Anaphylaxis

Indications:
- Acute onset of severe illness after exposure to a known allergen with two or more of the following:
  - Urticaria (hives) or acute swelling of the mucosa
  - Respiratory compromise
  - Hypotension
  - GI symptoms
- Acute onset of severe illness after exposure to a known allergen with hypotension
BLS interventions:
- Adult:
  - Epinephrine auto-injector (0.3 mg IM) or epinephrine (0.5 mg IM)
  - Albuterol inhaler (2 puffs) or nebulized albuterol (2.5 mg)
- Pediatric:
  - Less than 5 years: pediatric epinephrine auto-injector (0.15 mg IM) or epinephrine (0.15 mg IM)
  - 5 years or older: epinephrine auto-injector (0.3 mg IM) or epinephrine (0.5 mg IM)
  - Albuterol inhaler (2 puffs) or nebulized albuterol (1.25 mg or 2.5 mg depending on age)

Apparent Life-Threatening Event/Brief Resolved Unexplained Event (ALTE/BRUE)

Indications:
- Infant or child less than 2 years of age
- Episode that is frightening to the observer, including apnea, skin color change, marked change in muscle tone, or choking/gagging
BLS interventions:
- Perform assessment using the Pediatric Assessment Triangle
- Obtain a description of the event and assess the environment for possible causes
- Apply oxygen and be prepared to support ventilation during transport
- Consult with a Pediatric Base Station physician if the parent or guardian refuses medical care or transport

HYPOglycemia/HYPERglycemia

Indications:
- Blood glucose less than 70 mg/dL or greater than 300 mg/dL
- Patient-reported low or high blood glucose
- Diabetic patients with other medical symptoms
- Altered mental status, alcohol intoxication, seizure, stroke, unresponsive patients, or cardiac arrest
BLS interventions:
- Adult and pediatric:
  - Check blood glucose level
  - Administer 10-15 grams of oral glucose if blood glucose is less than 70 mg/dL
  - Repeat dose if not improved after 10 minutes

Hyperkalemia

Indications:
- Renal failure or chronic kidney disease patients
- Renal dialysis patients who are hemodynamically unstable
- Crush syndrome (entrapped patients with prolonged extrication time)
BLS interventions:
- Adult and pediatric:
  - Place patient in position of comfort
  - Assess and treat for shock, if indicated

Nausea/Vomiting

Indications:
- Nausea or vomiting
- Active motion sickness
- Medication side effect/complication
- Prevention of nausea/vomiting (e.g., penetrating eye injury, high risk for aspiration, opioid administration)
BLS interventions:
- Adult and pediatric:
  - Place patient in position of comfort or in left lateral position
  - Allow patient to inhale vapor from an isopropyl alcohol wipe 3 times every 15 minutes, as needed and tolerated

Pain Management

Indications:
- Mild to moderate pain: pain rated in the 1-5 range on a scale of 1-10
- Moderate to severe pain: pain rated in the 5-10 range on a scale of 1-10
BLS interventions:
- Adult:
  - Acetaminophen for mild to moderate pain (640 mg or 650 mg)
  - Opioid analgesia for moderate to severe pain
- Pediatric:
  - Acetaminophen for mild to moderate pain (160 mg or 325 mg)
  - Opioid analgesia for moderate to severe pain
- Clinical pearls: administration of pain medication does not eliminate the need for transport, use caution with opioids, and observe for evidence of hypotension and respiratory depression.### Pain Rating Scale
Hurts Worse, Hurts Whole Lot, Hurts Even More, Hurts Little Worse, Hurts Little Bit, and No Hurt are the descriptors used to rate pain, with 10 being the worst pain possible and 0 being no pain.
The pain rating scale is divided into categories, with 10 being unbearable, 8-9 being intense, 7 being severe, 6 being miserable, 5 being moderate, 4 being nagging, 3 being uncomfortable, 2 being mild, and 1 being annoying.

Pain Management - Pediatric

For mild to moderate pain (1-5 on the FACES scale), acetaminophen is recommended for children and parents.
The dosage of acetaminophen varies by age:
- Under 3 months: Not indicated
- 3 months to 2 years: 1.25 mL to 3.75 mL
- 2-4 years: One unit dose of 160 mg/5 mL
- 5-12 years: Two unit doses of 160 mg/5 mL each
- 13 years and above: Four unit doses of 160 mg/5 mL each or 325 mg pill/tablet x2

Clinical Pearls

Administering pain medication does not eliminate the need for transporting the patient to the hospital for a comprehensive evaluation and treatment.
Ketamine is only indicated for musculoskeletal and back pain, not for chest pain, abdominal/flank pain, or headaches.

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Description

This quiz assesses a healthcare professional's ability to identify and respond to agitation in patients, including mild, moderate, and severe symptoms. It covers scene safety, patient assessment, and requesting law enforcement assistance.