Violence, Management of

Violence, Management of is a topic covered in the 5-Minute Emergency Consult.

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  • EDs and waiting rooms are areas of high prevalence for violence
  • Higher risk associated with busier EDs
  • Patients with primary psychiatric complaints are likely to be boarding >24 hr and may not be receiving psychiatric care
  • Risk factors for violence in the ED:
    • Prior history of violence OR being a victim of violence
    • Patient arriving in police custody
    • Substance abuse history/intoxication
    • Poor impulse control
    • Male gender
    • Psychiatric illness (complex relationship to risk)
  • No clear difference in risk associated with:
    • Ethnicity
    • Language
    • Education
    • Medical diagnosis


  • Primary psychiatric problem:
    • Most commonly psychosis or mania, but associated with many different diagnoses
  • Acute primary medical problem:
    • Infection
    • Metabolic:
      • Hypoglycemia
      • Hypoxia
      • Hypothermia or hyperthermia
    • Toxicologic:
      • Alcohol intoxication or withdrawal
      • Illicit drug intoxication or withdrawal
      • Sedatives
      • Pain medications
      • Anticholinergics
      • Steroids
    • Neurologic:
      • Seizure
      • Stroke
      • Head injury or bleed
      • Brain lesion or mass
  • Chronic primary medical problem:
    • Dementia
    • Intellectual disability
    • Traumatic brain injury
  • Criminal behavior or psychopathy

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