MedBugs: SAQ #619

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Case: Paediatric Agitation and Carer Concern

A 13 year old boy presents via ambulance from home with acute behavioural disturbance. He is autistic, non-verbal and has intellectual impairment. His mother is following in a car. The ambulance crew have had to physically restrain him under a net. He is in the ambulance bay, spitting when anyone approaches him.

1. State 4 actions you might take to help de-escalate the situation. 4 marks

He is now calm and you are able to examine him. Vital signs are normal and he is afebrile. Cardiorespiratory exam is unremarkable. His abdomen in soft but slightly distended with mild generalised tenderness. No signs of physical injury. With mum’s consent, you decide to perform some blood tests.

2. What is your approach to doing blood tests? 1 mark

His blood tests are unremarkable and you are reassured that there is no acute medical issue. You suggest that they can go home. Mum is refusing to leave and believes there is something wrong.

3. What will you do next when mum is refusing discharge and believes something is wrong? 4 marks

Whilst discussions are being held, the patient gets increasingly agitated, hitting his head on a wall, spitting at his mother and biting her hand. You think chemical restraint is needed.

4. What agent will you use? Include dose, route and one undesired effect. 3 marks

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Case: Paediatric Agitation and Carer Concern

1. State 4 actions you might take to help de-escalate the situation. 4 marks

2. What is your approach to doing blood tests? 1 mark

3. What will you do next when mum is refusing discharge and believes something is wrong? 4 marks

4. What agent will you use? Include dose, route and one undesired effect. 3 marks

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