The Acutely Agitated Adult ED Patient

DETERMINE GOALS

1. Calm the patient 
2. Minimize dangerous and aggressive behavior 
3. Expedite treatment of the patient’s underlying condition 

IDENTIFY RELEVANT PATIENT CHARACTERISTICS

1. Renal and hepatic function 
2. Age (i.e. elderly, pregnant, etc.) 
3. Source of agitation (drug induced vs psychiatric) 

EVALUATE ROUTE OF ADMINISTRATION BENEFIT VS RISK

1. 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”.  
2. 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. 
3. 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