Management of Aggression in Emergency Departments is more than just PRNs

Anik Jhonsa, MD

In recent years pediatric emergency departments have seen a dramatic rise in the number of children and families presenting seeking mental health treatment.  As a child and adolescent psychiatrist primarily working in the emergency room, I’m often asked by my Emergency Medicine colleagues to develop an “agitation plan” for patients who are deemed at risk of acting out in an aggressive manner.  Most often these requests tend to focus on the PRN medication plan should a child become aggressive or upset.  However, most successful agitation plans begin well before any medication needs to be administered. read more

Infant Respiratory Distress with Hypotonia: Casting a Broad Differential

Dr. Anya Kleinman

Case Presentation:

Two-month-old male presented with unknown duration of respiratory distress. He had been “breathing fast since birth” with no acute fevers, vomiting, or sick contacts. Review of systems is notable for diffuse muscle weakness and chronic coughing with feeds. Developmental history is significant for lifelong decreased movement and inability to lift head when prone. No family history of motor delay or decreased tone.

Vitals: afebrile, HR 163, RR 68, PO2 92%. Patient is ill-appearing with minimal response to tactile stimuli. The evident tachypnea is associated with increased abdominal muscle use with retractions and grunting. Neurological exam has open, flat, anterior fontanelle with profound head lag and “frog-legging” of lower extremities. Deep tendon reflexes cannot be elicited. Skin exam is negative for rashes or hematomas. read more