Best Practices in Managing Child and Adolescent Behavioral Health Emergencies (Pharmacology CME)

Best Practices in Managing Child and Adolescent Behavioral Health Emergencies (Pharmacology CME) is organized by EB Medicine.

Date of Original Release: January 1, 2018
Date of most recent review: December 15, 2017
Termination date: January 1, 2021
CME Expiration Date: February 1, 2021

Accreditation:
Credit Designation:
EB Medicine designates this enduring material for a maximum of 4 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ACEP Accreditation:
Pediatric Emergency Medicine Practice is also approved by the American College of Emergency Physicians for 48 hours of ACEP Category I credit per annual subscription.

AAP Accreditation:
This continuing medical education activity has been reviewed by the American Academy of Pediatrics and is acceptable for a maximum of 48 AAP credits per year. These credits can be applied toward the AAP CME/CPD Award available to Fellows and Candidate Fellows of the American Academy of Pediatrics.

AOA Accreditation:
Pediatric Emergency Medicine Practice is eligible for up to 48 American Osteopathic Association Category 2-A or 2-B credit hours per year.

Other Specialty CME:
Included as part of the 4 credits, this CME activity is eligible for 4 Behavioral Health CME and 1 Pharmacology CME credits, subject to your state and institutional requirements.

Abstract:
Behavioral health emergencies most commonly present as depression, suicidal behavior, aggression, and severe disorganization. Emergency clinicians should avoid relying solely on past medical history or previous psychiatric diagnoses that might prematurely rule out medical pathologies. Treatments for behavioral health emergencies consist of de-escalation interventions aimed at preventing agitation, aggression, and harm. This issue reviews medical pathologies and underlying causes that can result in psychiatric presentations and summarizes evidence-based practices to evaluate, manage, and refer patients with behavioral health emergencies.

Description:
It is often assumed that a behavioral health issue is solely due to a psychiatric cause. However, many medical pathologies may present with behavior problems and must be ruled out. In this issue, you will learn:
• Risk factors for suicide, aggression, and violence
• The common presentations of behavioral health emergencies, including depression, anxiety, suicidal behavior, aggression, and severe disorganization, as well as potential underlying medical causes of these behaviors
• Steps to ensure a safe environment for the patient and ED staff
• Key aspects of evaluating and examining patients with suicidal behaviors, psychosis, and disorganized behaviors
• When screening laboratory tests and radiologic studies are warranted
• Environmental, verbal, pharmacologic, and physical de-escalation interventions
• Which patients require inpatient psychiatric or medical admission, as well as various options for outpatient care

Goals: 
Upon completion of this activity, you should be able to: 
• Demonstrate medical decision-making based on the strongest clinical evidence; 
• Cost-effectively diagnose and treat the most critical ED presentations; and
• Describe the most common medicolegal pitfalls for each topic covered.

Objectives:
Upon completion of this article, you should be able to:
• Discuss the differential diagnosis, evaluation, workup, and disposition planning for acute presentations of behavioral emergencies
• Recognize emergency presentations related to side effects of psychotropic medications
• Describe the steps involved in behavioral and pharmacologic management of agitation in children and adolescents
• Discuss challenges in triage, consultation, medical or psychiatric clearance, legal issues, and disparities unique to the behavioral health needs of patients in emergency settings.