Approach every patient as though they have had a past traumatic experience to ensure they feel safe and in control.
Consider speaking with an adolescent patient and caregiver separately to provide privacy while also obtaining collateral history from caregivers.
Give patient and caregiver information about what to expect during the ED visit (e.g., wait times, nursing checks, evaluation by emergency physician (and learners) to determine best plan, how information will be communicated).

Consider who should be with the patient for reassurance.
Ask the patient what would be helpful and offer suggestions such as music, food, or a warm blanket.
Check in with caregiver to ensure their comfort. Do they need breaks and how staff can support them?

Experiences that are uncomfortable, novel, or frightening can result in physical and emotional anxiety- based responses (e.g., mind-body connection).
Validate the distress arising from physical symptoms of anxiety and explain that these symptoms are not dangerous.²
Anxiety occurs on a spectrum from adaptive (e.g., distress in a new/difficult situation that can be overcome) to maladaptive (e.g., extreme emotional responses are experienced and new/uncomfortable situations are avoided).
There may be identifiable precipitants, symptoms may be present for brief periods of time, or symptoms may be chronic in nature.

Active distraction: Playing with an electronic device (smartphone, tablet), square or 5-finger breathing.
Passive distraction: Watching TV, listening to music.
Support from allied health professional (e.g., RN, Social Worker, Child Life Specialist), if available.

Pharmacotherapy should be reserved for patients with severe anxiety resulting in serious behavioral escalation and acute safety concerns during the ED visit. Refer to TREKK’s Care of the Agitated Patient Algorithm.
Lorazepam is the preferred first-line medication for use in the ED for severe anxiety³:
– 0.05 mg/kg/dose, range 0.02 – 0.05 mg/kg/dose, MAX 2 mg/dose PO/SL q 4-8h PRN