Paeds Vivas · mental-behavioural-and-psychosomatic
Acute behavioural disturbance and agitation — branching viva
Branching viva on classifying acute agitation by severity and cause, the least-restrictive ladder, verbal de-escalation, oral and parenteral pharmacotherapy grounded in the PEAChY trials, excluding organic causes, and minimising and recovering from restraint.
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Target exams
RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
You are the paediatric registrar in the emergency department. The examiner moves from classification to the least-restrictive ladder, pharmacotherapy, organic-cause exclusion, and a restraint-and-recovery scenario.
Stem
The examiner will test whether you can classify acute agitation, run the least-restrictive ladder, choose pharmacotherapy with evidence, exclude organic causes, and manage restraint and recovery safely. [1] [3]
References8ShowHide
- [1]Gerson R Best Practices for Evaluation and Treatment of Agitated Children and Adolescents (BETA) in the Emergency Department: Consensus Statement of the American Association for Emergency Psychiatry. West J Emerg Med, 2019.PMID 30881565
- [2]Hoffmann JA Pharmacologic Management of Acute Agitation in Youth in the Emergency Department. Pediatr Emerg Care, 2021.PMID 34397677
- [3]Foster AA Approach to acute agitation in the pediatric emergency department. Curr Opin Pediatr, 2024.PMID 38299972
- [4]Mills KP Pharmacotherapy considerations for pediatric acute agitation management in the emergency department. Am J Health Syst Pharm, 2024.PMID 39008306
- [5]Bourke EM PEAChY-O: Pharmacological Emergency Management of Agitation in Children and Young People: A Randomized Controlled Trial of Oral Medication. Ann Emerg Med, 2025.PMID 39955661
- [6]Bourke EM Pharmacological Emergency management of Agitation in Children and Young people: protocol for a randomised controlled trial of intraMuscular medication (PEAChY-M). BMJ Open, 2023.PMID 36997241
- [7]Klein K Non-pharmacological de-escalation techniques used to manage acute severe behavioural disturbance in children and adolescents presenting to emergency departments: secondary analysis of a randomised controlled trial. Arch Dis Child, 2026.PMID 41015487
- [8]Perers C Methods and Strategies for Reducing Seclusion and Restraint in Child and Adolescent Psychiatric Inpatient Care. Psychiatr Q, 2022.PMID 33629229