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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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Rosen, Peter, et al., editors. "Violence, Management Of." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307327/all/Violence__Management_of.
Violence, Management of. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307327/all/Violence__Management_of. Accessed April 25, 2019.
Violence, Management of. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307327/all/Violence__Management_of
Violence, Management Of [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307327/all/Violence__Management_of.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Violence, Management of ID - 307327 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307327/all/Violence__Management_of PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -