What do you take into consideration when you’re presented with an acutely agitated adult? Do you have a drug of choice? Or perhaps a go-to cocktail? While most of the time these patients present to the ED and require immediate decision making, there may be an opportunity to identify etiology, comorbidities, and some medical history
- Calm the patient
- Minimize dangerous and aggressive behavior
- Expedite treatment of the patient’s underlying condition
IDENTIFY RELEVANT PATIENT CHARACTERISTICS
- Renal and hepatic function
- Age (i.e. elderly, pregnant, etc.)
- Source of agitation (drug induced vs psychiatric)
EVALUATE ROUTE OF ADMINISTRATION BENEFIT VS RISK
- In scenarios where patients do not require immediate therapeutic effect, oral medications are considered first line when possible as they are less interventional to the patient. Oral solutions and dissolvable tablets are preferred to prevent diversion or “cheeking”.
- In acute scenarios where oral is not practical and the patient does not have an intravenous line in place, use the intramuscular route of administration.
- Intravenous route is generally the least preferred option as it is associated with greater risk of adverse events inclusive of dystonia, cardiovascular or respiratory compromise.
REVIEW AND DECIDE ON YOUR MEDICATION(S) BASED ON CHARACTERISTICS
Baker SN. Management of acute agitation in the emergency department. Adv Emerg Nurs J. 2012;34(4):306-320. doi:10.1097/TME.0b013e31826f12d6
Lexicomp Online, Pediatric and Neonatal Lexi-Drugs Online, Hudson, Ohio: UpToDate, Inc.; 2013; April 15, 201
Wilson MP, Pepper D, Currier GW, Holloman GH Jr, Feifel D. The psychopharmacology of agitation: consensus statement of the American association for emergency psychiatry project Beta psychopharmacology workgroup. West J Emerg Med. 2012; 13(1):26-34. doi:10.5811/westjem.2011.9.6866