Artículo especial
Atención al paciente agitado, violento o psicótico en urgencias: un protocolo pendiente para una patología en aumento
Management of agitated, violent or psychotic patients in the emergency department: an overdue protocol for an increasing problem
M.T. Jiménez Busseloa,
, J. Aragó Domingoa, A. Nuño Ballesterosa, J. Loño Capoteb, G. Ochando Peralesb
Corresponding author
maite.jimenez@telefonica.net
Correspondencia: Dra. M.ª T. Jiménez Busselo. Urgencias de Pediatría. Hospital Infantil Universitario La Fe. Avda. Campanar, s/n. 46009 Valencia. España.
Correspondencia: Dra. M.ª T. Jiménez Busselo. Urgencias de Pediatría. Hospital Infantil Universitario La Fe. Avda. Campanar, s/n. 46009 Valencia. España.
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"apellidos" => "Jiménez Busselo" "email" => array:1 [ 0 => "maite.jimenez@telefonica.net" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Aragó Domingo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Nuño Ballesteros" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "Loño Capote" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] ] 4 => array:3 [ "nombre" => "G." "apellidos" => "Ochando Perales" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Área de Urgencias de Pediatría. Hospital Infantil Universitario La Fe. Valencia. España" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Unidad de Paidopsiquiatría. Hospital Infantil Universitario La Fe. Valencia. España" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Correspondencia: Dra. M.ª T. Jiménez Busselo. Urgencias de Pediatría. Hospital Infantil Universitario La Fe. Avda. Campanar, s/n. 46009 Valencia. España." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Management of agitated, violent or psychotic patients in the emergency department: an overdue protocol for an increasing problem" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2005-06-30" "fechaAceptado" => "2005-07-31" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec186285" "palabras" => array:7 [ 0 => "Agitación psicomotriz" 1 => "Contención química" 2 => "Contención física" 3 => "Crisis psicótica" 4 => "Comportamiento violento" 5 => "Servicio de urgencias" 6 => "Niños" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec186286" "palabras" => array:7 [ 0 => "Psychomotor agitation" 1 => "Chemical restraint" 2 => "Physical restraint" 3 => "Violent behavior" 4 => "Psychotic disorder" 5 => "Emergency department" 6 => "Children" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<p class="elsevierStyleSimplePara elsevierViewall">El paciente con extrema agitación, delirio, comportamiento violento o psicosis aguda es un problema de evaluación frecuente en la sala de urgencias de un hospital general. En cambio, en los servicios de urgencias pediátricas, la tradicional infrecuencia de este tipo de cuadros puede conducir a un cierto grado de imprevisión e ineficiencia en la atención inicial a estos casos.</p><p class="elsevierStyleSimplePara elsevierViewall">El actual incremento conocido de la patología de origin psicosocial en las urgencias pediátricas, las nuevas terapias medicamentosas de los procesos psicóticos juveniles y, más en particular su incumplimiento, así como la aproximación más temprana de nuestros jóvenes al consume de sustancias adictivas, cada vez más variadas, nos enfrentan a un aumento en la frecuencia y la diversidad de este tipo de crisis.</p><p class="elsevierStyleSimplePara elsevierViewall">El tratamiento de la agitación, agresión y/o violencia empieza con el tratamiento exitoso del episodio agudo, seguido por estrategias destinadas a reducir la intensidad y frecuencia de los episodios subsiguientes. La clave para la seguridad es intervenir precozmente con objeto de prevenir la progresión de la agitación a agresión y violencia. Por eso, las medidas urgentes, destinadas a inhibir la agitación, deben ser adoptadas sin demora por el personal que atiende primero al paciente, y que suele ser en las unidades de urgencias.</p><p class="elsevierStyleSimplePara elsevierViewall">Los pacientes en crisis de agitación psicomotriz (CAPM) pueden requerir medidas urgentes de contención físicay/o química, para asegurar su propia integridad, la seguridad de sus cuidadores sanitarios, prevenir secuelas clínicas graves y permitir su evaluación clínica para determiner la etiología. Pero los riesgos derivados de las medidas de contención deben conocerse y ser sopesados frente a los beneficios en cada caso.</p><p class="elsevierStyleSimplePara elsevierViewall">El propósito de este artículo es exponer la actuación urgente que se debe seguir ante un niño con CAPM, intentando definir las distintas situaciones etiológicas y los criterios de elección de medicamentos para el control químico en cada una de ellas, así como advertir de las complicaciones asociadas a los agentes medicamentosos que emplear y de la conveniencia, por tanto, de que los profesionales se familiaricen con las distintas opciones farmacológicas.</p>" ] "en" => array:1 [ "resumen" => "<p class="elsevierStyleSimplePara elsevierViewall">Patients with extreme agitation, delirium, violent behavior or acute psychosis are frequently evaluated in the emergency departments of general hospitals. However, the traditional infrequency of this type of situation in pediatric emergency services can lead to a certain lack of foresight and efficiency in the initial management of these patients.</p><p class="elsevierStyleSimplePara elsevierViewall">Because of the current known increase of psychosocial disorders in pediatric emergencies, new pharmacological treatments for juvenile psychotic processes, and particularly the lack of compliance with these treatments, as well as the earlier consumption of ever more varied illicit drugs among young people, the frequency and diversity of this kind of disorder is on the increase.</p><p class="elsevierStyleSimplePara elsevierViewall">The treatment of agitation, aggression and violence begins with successful management of the acute episode, followed by strategies designed to reduce the intensity and frequency of subsequent episodes. The key to safety is early intervention to prevent progression from agitation to aggression and violence. Consequently, urgent measures designed to inhibit agitation should be adopted without delay by the staff initially dealing with the patient, usually in the emergency unit.</p><p class="elsevierStyleSimplePara elsevierViewall">Patients with psychomotor agitation disorder (PMAD) may require emergency physical and/or chemical restraints for their own safety and that of the healthcare provider in order to prevent harmful clinical sequelae and to expedite medical evaluation to determine the cause. However, the risks of restraint measures must be weighed against the benefits in each case.</p><p class="elsevierStyleSimplePara elsevierViewall">This review aims to present the emergency measures to be taken in children with PMAD. The distinct etiological situations and criteria for the choice of drugs for chemical restraint in each situation, as well as the complications associated with certain drugs, are discussed. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 23 | 24 | 47 |
| 2024 October | 271 | 127 | 398 |
| 2024 September | 188 | 101 | 289 |
| 2024 August | 191 | 130 | 321 |
| 2024 July | 184 | 91 | 275 |
| 2024 June | 148 | 109 | 257 |
| 2024 May | 169 | 92 | 261 |
| 2024 April | 174 | 121 | 295 |
| 2024 March | 132 | 96 | 228 |
| 2024 February | 200 | 106 | 306 |
| 2024 January | 199 | 92 | 291 |
| 2023 December | 138 | 76 | 214 |
| 2023 November | 202 | 102 | 304 |
| 2023 October | 178 | 84 | 262 |
| 2023 September | 128 | 59 | 187 |
| 2023 August | 119 | 62 | 181 |
| 2023 July | 148 | 80 | 228 |
| 2023 June | 158 | 80 | 238 |
| 2023 May | 149 | 70 | 219 |
| 2023 April | 81 | 48 | 129 |
| 2023 March | 147 | 85 | 232 |
| 2023 February | 86 | 76 | 162 |
| 2023 January | 63 | 74 | 137 |
| 2022 December | 76 | 69 | 145 |
| 2022 November | 101 | 78 | 179 |
| 2022 October | 84 | 60 | 144 |
| 2022 September | 86 | 92 | 178 |
| 2022 August | 71 | 98 | 169 |
| 2022 July | 100 | 92 | 192 |
| 2022 June | 106 | 74 | 180 |
| 2022 May | 109 | 71 | 180 |
| 2022 April | 78 | 93 | 171 |
| 2022 March | 71 | 103 | 174 |
| 2022 February | 73 | 84 | 157 |
| 2022 January | 76 | 69 | 145 |
| 2021 December | 57 | 82 | 139 |
| 2021 November | 114 | 99 | 213 |
| 2021 October | 115 | 114 | 229 |
| 2021 September | 86 | 85 | 171 |
| 2021 August | 80 | 95 | 175 |
| 2021 July | 105 | 94 | 199 |
| 2021 June | 75 | 91 | 166 |
| 2021 May | 76 | 128 | 204 |
| 2021 April | 131 | 267 | 398 |
| 2021 March | 101 | 124 | 225 |
| 2021 February | 106 | 126 | 232 |
| 2021 January | 105 | 70 | 175 |
| 2020 December | 69 | 99 | 168 |
| 2020 November | 109 | 83 | 192 |
| 2020 October | 61 | 66 | 127 |
| 2020 September | 69 | 54 | 123 |
| 2020 August | 71 | 87 | 158 |
| 2020 July | 57 | 57 | 114 |
| 2020 June | 83 | 85 | 168 |
| 2020 May | 178 | 62 | 240 |
| 2020 April | 68 | 67 | 135 |
| 2020 March | 51 | 35 | 86 |
| 2020 February | 59 | 70 | 129 |
| 2020 January | 78 | 61 | 139 |
| 2019 December | 68 | 112 | 180 |
| 2019 November | 55 | 153 | 208 |
| 2019 October | 75 | 151 | 226 |
| 2019 September | 42 | 152 | 194 |
| 2019 August | 65 | 196 | 261 |
| 2019 July | 56 | 203 | 259 |
| 2019 June | 47 | 194 | 241 |
| 2019 May | 116 | 150 | 266 |
| 2019 April | 122 | 174 | 296 |
| 2019 March | 80 | 89 | 169 |
| 2019 February | 54 | 73 | 127 |
| 2019 January | 56 | 77 | 133 |
| 2018 December | 44 | 48 | 92 |
| 2018 November | 76 | 83 | 159 |
| 2018 October | 87 | 78 | 165 |
| 2018 September | 30 | 38 | 68 |
| 2018 August | 2 | 0 | 2 |
| 2018 July | 3 | 0 | 3 |
| 2018 June | 5 | 0 | 5 |
| 2018 May | 5 | 0 | 5 |
| 2018 April | 9 | 1 | 10 |
| 2018 March | 6 | 1 | 7 |
| 2018 February | 10 | 1 | 11 |
| 2018 January | 3 | 1 | 4 |
| 2017 December | 6 | 0 | 6 |
| 2017 November | 8 | 1 | 9 |
| 2017 October | 14 | 1 | 15 |
| 2017 September | 11 | 2 | 13 |
| 2017 August | 8 | 1 | 9 |
| 2017 July | 6 | 14 | 20 |
| 2017 June | 20 | 172 | 192 |
| 2017 May | 26 | 201 | 227 |
| 2017 April | 10 | 172 | 182 |
| 2017 March | 16 | 205 | 221 |
| 2017 February | 8 | 208 | 216 |
| 2017 January | 11 | 87 | 98 |
| 2016 December | 30 | 116 | 146 |
| 2016 November | 40 | 192 | 232 |
| 2016 October | 52 | 189 | 241 |
| 2016 September | 78 | 279 | 357 |
| 2016 August | 133 | 129 | 262 |
| 2016 July | 77 | 141 | 218 |
| 2016 June | 4 | 112 | 116 |
| 2016 May | 4 | 162 | 166 |
| 2016 April | 5 | 180 | 185 |
| 2016 March | 7 | 0 | 7 |
| 2016 February | 2 | 70 | 72 |
| 2016 January | 1 | 0 | 1 |
| 2015 December | 5 | 78 | 83 |
| 2015 November | 3 | 97 | 100 |
| 2015 October | 6 | 105 | 111 |
| 2015 September | 5 | 0 | 5 |
| 2015 August | 2 | 0 | 2 |
| 2015 July | 28 | 42 | 70 |
| 2015 June | 14 | 58 | 72 |
| 2015 May | 17 | 0 | 17 |
| 2015 April | 15 | 39 | 54 |
| 2015 March | 12 | 44 | 56 |
| 2015 February | 16 | 22 | 38 |
| 2015 January | 32 | 3 | 35 |
| 2014 December | 23 | 10 | 33 |
| 2014 November | 18 | 2 | 20 |
| 2014 October | 28 | 2 | 30 |
| 2014 September | 29 | 3 | 32 |
| 2014 August | 44 | 2 | 46 |
| 2014 July | 61 | 3 | 64 |
| 2014 June | 75 | 7 | 82 |
| 2014 May | 168 | 7 | 175 |
| 2014 April | 159 | 5 | 164 |
| 2014 March | 154 | 19 | 173 |
| 2014 February | 167 | 17 | 184 |
| 2014 January | 119 | 10 | 129 |
| 2013 December | 114 | 11 | 125 |
| 2013 November | 95 | 17 | 112 |
| 2013 October | 96 | 21 | 117 |
| 2013 September | 80 | 18 | 98 |
| 2013 August | 89 | 23 | 112 |
| 2013 July | 54 | 8 | 62 |
| 2013 June | 6 | 5 | 11 |
| 2013 May | 6 | 3 | 9 |
| 2013 April | 9 | 2 | 11 |
| 2013 March | 11 | 1 | 12 |
| 2013 February | 47 | 1 | 48 |
| 2013 January | 71 | 1 | 72 |
| 2012 December | 55 | 1 | 56 |
| 2012 November | 36 | 1 | 37 |
| 2012 October | 74 | 1 | 75 |
| 2012 September | 2 | 0 | 2 |
| 2005 December | 8167 | 0 | 8167 |
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