Ep 217 Pediatric Agitation: Assessment and Management

Emergency Medicine Cases

Dr. Anton Helman

Education, Health & Fitness, Courses, Medicine, Science

4.7 • 602 Ratings

🗓️ 28 April 2026

⏱️ 82 minutes

🔗️ Recording | iTunes | RSS

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Summary

Pediatric agitation in the Emergency Department is one of those presentations that can escalate quickly and leave even experienced clinicians feeling on edge. It is high-risk, resource-intensive, and often unfolds in an already overstimulating environment where small missteps can make things worse. At the same time, agitation is not a diagnosis, it is a clinical presentation that may reflect anything from psychiatric illness to delirium, intoxication, trauma, or simply a child overwhelmed by the ED itself. So how do we approach these patients in a way that is safe, systematic, and effective? In this episode with guest experts, Dr. Susan Duffy and Dr. Thomas Chun, we tackle the questions that come up at the bedside: How do we rapidly distinguish mild, moderate, and severe agitation in a way that actually changes what we do next? Which patients are most likely to escalate, and how can we intervene early to prevent that? When should we be worried about a medical or toxicologic cause rather than assuming this is “behavioural”? What does effective verbal de-escalation actually look like in a busy ED, and why does it so often fail? When is a "code white" for emergency security measures truly indicated, and how do we avoid turning it into an escalation trigger? How should we be thinking about medications: what to choose, when to give them, and how to avoid over-sedation? And once the patient is finally calm, how do we make sure we aren't missing the underlying diagnosis? and many more... Please consider a donation to EM Cases to support ongoing high quality Free Open Access Medical Education https://emergencymedicinecases.com/donation/

Transcript

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0:00.0	Emergency medicine is more than just ordered chaos.
0:04.5	From the recess room to the bedside, we are witness to it all.
0:07.9	And we're here to help you prepare for it.
0:10.3	Bringing you the brightest minds in emergency medicine from around the world for trusted,
0:14.8	tried, and true free open access medical education.
0:18.0	I'm Dr. Anton Hellman.
0:19.6	And I'm Dr. Katie Lynn. Katie, let's welcome the listeners
0:22.7	from our amazing EM community to the Emergency Medicine Cases podcast, shall we? Yeah. Or let's simply call it
0:28.7	EM cases. Okay, EM Cases. EM cases is brought to you by Shremi, the Schwartz-Rizman Emergency Medicine
0:35.6	Institute. That's a non-profit organization dedicated to improving EM care through high-quality research and education. The opinions expressed on this podcast are intended for information and education purposes only and should not be used to diagnose, treat, or prevent any medical condition, nor should they be used as a substitute for medical advice from qualified practicing physicians. First, just a quick word from our sponsor Metricade, the experts in complex physician scheduling since 2012. I've been using
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1:30.8	ED visits for pediatric mental health and behavioral emergencies have surged over the last
1:35.7	decade, and we're seeing more and more agitated children and teenagers in our practices.
1:40.8	But many hospitals lack pediatric specific guides, policies, and procedures to help us
1:45.5	manage this population well. And the management of these patients is not so simple. It depends on the
1:51.5	severity of the agitation, the etiology of the agitation, the underlying stressor, and the
1:56.7	resources that you have at hand. A poorly managed, agitated child can be detrimental not only to the
	...

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