Agitated or combative patient - Revision history

Danbot: Strip excess bold

2026-03-22T09:37:12Z

Strip excess bold

← Revisión anterior		Revisión del 09:37 22 mar 2026
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	***[[Personality disorders]] - (e.g. antisocial personality disorder patients may lack remorse for violent actions_		***[[Personality disorders]] - (e.g. antisocial personality disorder patients may lack remorse for violent actions_
	***[[bipolar disorder\|Mania]] - unpredictable because of emotional lability		***[[bipolar disorder\|Mania]] - unpredictable because of emotional lability
	**Increased ~~'''~~waiting~~'''~~ duration (for evaluation, results, treatment, etc)		**Increased waiting duration (for evaluation, results, treatment, etc)
	*Factors that '''do not''' predict violence		*Factors that '''do not''' predict violence
	**Ethnicity, diagnosis, age, marital status, and education		**Ethnicity, diagnosis, age, marital status, and education
	**Evaluation by psychiatrist, ~~'''~~regardless of experience~~'''~~		**Evaluation by psychiatrist, regardless of experience

	==Clinical Features==		==Clinical Features==
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	==Evaluation==		==Evaluation==
	*~~'''~~Screen for acute medical conditions that may contribute to the patient's behavior.~~'''~~		*Screen for acute medical conditions that may contribute to the patient's behavior.
	**Always obtain:		**Always obtain:
	***Blood glucose		***Blood glucose
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	***Cranial imaging		***Cranial imaging
	***Electroencephalography		***Electroencephalography
	*~~'''~~Unnecessary diagnostic testing prolongs ED stay and delays definitive psychiatric care.~~'''~~		*Unnecessary diagnostic testing prolongs ED stay and delays definitive psychiatric care.
	**~~'''~~Organic cause unlikely~~'''~~ → ''may not'' require further workup		**Organic cause unlikely → ''may not'' require further workup
	***Younger than 40 years		***Younger than 40 years
	***Prior psychiatric history		***Prior psychiatric history
Línea 99:		Línea 99:
	****Normal orientation		****Normal orientation
	****No physical complaints		****No physical complaints
	**~~'''~~Organic cause more likely~~'''~~ → ''does'' require further workup		**Organic cause more likely → ''does'' require further workup
	***Acute onset of agitated behavior		***Acute onset of agitated behavior
	***Behavior that waxes and wanes over time		***Behavior that waxes and wanes over time
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	*Screen for weapons and disarm prior to entrance to ED		*Screen for weapons and disarm prior to entrance to ED
	*'''Violence may occur without warning'''		*'''Violence may occur without warning'''
	*~~'''~~Be aware of surroundings~~'''~~		*Be aware of surroundings
	**Signs of anger, resistance, aggression, hostility, argumentativeness, violence		**Signs of anger, resistance, aggression, hostility, argumentativeness, violence
	**Accessibility of door for escape		**Accessibility of door for escape
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	**Respond in a calm and soothing tone		**Respond in a calm and soothing tone
	**Express concern/worry about the patient		**Express concern/worry about the patient
	*~~'''~~Three Fs framework~~'''~~:		*Three Fs framework:
	**I understand how you could ~~'''~~feel~~'''~~ that way.		**I understand how you could feel that way.
	**Others in that situation have ~~'''~~felt~~'''~~ that way, too.		**Others in that situation have felt that way, too.
	**Most have ~~'''~~found~~'''~~ that _____ helps."		**Most have found that _____ helps."
	*~~'''~~Avoid argumentation, machismo, and condescension~~'''~~		*Avoid argumentation, machismo, and condescension
	*'''Do not ''threaten'' ''' to call security — Invites patient to challenge with violence		*'''Do not ''threaten'' ''' to call security — Invites patient to challenge with violence
	*'''Do not ''deceive'' ''' (eg, about estimated wait times) — Invites violence when lie is uncovered		*'''Do not ''deceive'' ''' (eg, about estimated wait times) — Invites violence when lie is uncovered
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	===Physical restraints===		===Physical restraints===
	*~~'''~~Not for convenience or punishment~~'''~~		*Not for convenience or punishment
	*Indications for seclusion or restraint		*Indications for seclusion or restraint
	**Imminent danger to self, others, or environment		**Imminent danger to self, others, or environment

Danbot: Add MedicationDose SMW annotations for chemical restraint medications (7 drugs: droperidol, haloperidol, ketamine, midazolam, lorazepam, ziprasidone, olanzapine); dosing verified

2026-03-20T16:12:28Z

Add MedicationDose SMW annotations for chemical restraint medications (7 drugs: droperidol, haloperidol, ketamine, midazolam, lorazepam, ziprasidone, olanzapine); dosing verified

@@ Línea 206: / Línea 206: @@
 **Patient is in control and no longer violent
 ==See Also==
 *[[Sedation (main)]]

Masoodrm: /* Chemical Restraints (Rapid Tranquilization) */

2025-12-10T18:29:26Z

Chemical Restraints (Rapid Tranquilization)

← Revisión anterior		Revisión del 18:29 10 dic 2025
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	*Suggested protocol for continued agitation: antipsychotic Q5 min x 2, then ketamine IM		*Suggested protocol for continued agitation: antipsychotic Q5 min x 2, then ketamine IM
	**E.g. [[Droperidol]] 5mg (or [[haloperidol]] 5mg) IM Q5 min x 2, then [[ketamine]] 300mg IM		**E.g. [[Droperidol]] 5mg (or [[haloperidol]] 5mg) IM Q5 min x 2, then [[ketamine]] 300mg IM
	*[[Ketamine]], at a dose of 3-5 mg/kg IM, achieves sedation in 2-10 minutes. Few medications, if any, reliably achieve effective sedation this quickly following a single dose. <ref> Westafer, Lauren. “Patients with Severe Agitation in the ED.” ACEP NOW, vol. 42, no. 12, https://www.acepnow.com/article/which-sedatives-are-best-for-managing-severe-agitation-in-the-emergency-department/.</ref>.		*[[Ketamine]], at a dose of 4-6 mg/kg IM, achieves sedation in 2-10 minutes. Few medications, if any, reliably achieve effective sedation this quickly following a single dose. <ref> Westafer, Lauren. “Patients with Severe Agitation in the ED.” ACEP NOW, vol. 42, no. 12, https://www.acepnow.com/article/which-sedatives-are-best-for-managing-severe-agitation-in-the-emergency-department/.</ref>.
	*Other protocols involve combination therapy<ref>[http://www.emdocs.net/the-art-of-the-ed-takedown/ The Art of the ED Takedown EMDocs]</ref>.		*Other protocols involve combination therapy<ref>[http://www.emdocs.net/the-art-of-the-ed-takedown/ The Art of the ED Takedown EMDocs]</ref>.
	*Neuroleptics ([[Antipsychotics]])		*Neuroleptics ([[Antipsychotics]])

Masoodrm: /* Chemical Restraints (Rapid Tranquilization) */

2025-12-10T18:28:40Z

Chemical Restraints (Rapid Tranquilization)

← Revisión anterior		Revisión del 18:28 10 dic 2025
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	*If need to temporary physical restraint the patient: One arm up, one arm down, tie legs to opposite side of bed. [https://emcrit.org/emcrit/human-bondage-chemical-takedown/ Reference with video]		*If need to temporary physical restraint the patient: One arm up, one arm down, tie legs to opposite side of bed. [https://emcrit.org/emcrit/human-bondage-chemical-takedown/ Reference with video]
	*Suggested protocol for continued agitation: antipsychotic Q5 min x 2, then ketamine IM		*Suggested protocol for continued agitation: antipsychotic Q5 min x 2, then ketamine IM
	**E.g. [[Droperidol]] ~~10mg~~ (or [[haloperidol]] 5mg) IM Q5 min x 2, then [[ketamine]] 300mg IM		**E.g. [[Droperidol]] 5mg (or [[haloperidol]] 5mg) IM Q5 min x 2, then [[ketamine]] 300mg IM
	*[[Ketamine]], at a dose of 3-5 mg/kg IM, achieves sedation in 2-10 minutes. Few medications, if any, reliably achieve effective sedation this quickly following a single dose. <ref> Westafer, Lauren. “Patients with Severe Agitation in the ED.” ACEP NOW, vol. 42, no. 12, https://www.acepnow.com/article/which-sedatives-are-best-for-managing-severe-agitation-in-the-emergency-department/.</ref>.		*[[Ketamine]], at a dose of 3-5 mg/kg IM, achieves sedation in 2-10 minutes. Few medications, if any, reliably achieve effective sedation this quickly following a single dose. <ref> Westafer, Lauren. “Patients with Severe Agitation in the ED.” ACEP NOW, vol. 42, no. 12, https://www.acepnow.com/article/which-sedatives-are-best-for-managing-severe-agitation-in-the-emergency-department/.</ref>.
	*Other protocols involve combination therapy<ref>[http://www.emdocs.net/the-art-of-the-ed-takedown/ The Art of the ED Takedown EMDocs]</ref>.		*Other protocols involve combination therapy<ref>[http://www.emdocs.net/the-art-of-the-ed-takedown/ The Art of the ED Takedown EMDocs]</ref>.

Jonrako: /* Chemical Restraints (Rapid Tranquilization) */

2024-01-11T19:49:48Z

Chemical Restraints (Rapid Tranquilization)

← Revisión anterior		Revisión del 19:49 11 ene 2024
Línea 144:		Línea 144:
	*Suggested protocol for continued agitation: antipsychotic Q5 min x 2, then ketamine IM		*Suggested protocol for continued agitation: antipsychotic Q5 min x 2, then ketamine IM
	**E.g. [[Droperidol]] 10mg (or [[haloperidol]] 5mg) IM Q5 min x 2, then [[ketamine]] 300mg IM		**E.g. [[Droperidol]] 10mg (or [[haloperidol]] 5mg) IM Q5 min x 2, then [[ketamine]] 300mg IM
	**Other protocols involve combination therapy<ref>[http://www.emdocs.net/the-art-of-the-ed-takedown/ The Art of the ED Takedown EMDocs]</ref>.		*[[Ketamine]], at a dose of 3-5 mg/kg IM, achieves sedation in 2-10 minutes. Few medications, if any, reliably achieve effective sedation this quickly following a single dose. <ref> Westafer, Lauren. “Patients with Severe Agitation in the ED.” ACEP NOW, vol. 42, no. 12, https://www.acepnow.com/article/which-sedatives-are-best-for-managing-severe-agitation-in-the-emergency-department/.</ref>.
			*Other protocols involve combination therapy<ref>[http://www.emdocs.net/the-art-of-the-ed-takedown/ The Art of the ED Takedown EMDocs]</ref>.
	*Neuroleptics ([[Antipsychotics]])		*Neuroleptics ([[Antipsychotics]])
	**Atypical antipsychotics		**Atypical antipsychotics

Rossdonaldson1: /* Clinical Features */

2022-08-31T17:00:03Z

Clinical Features

← Revisión anterior		Revisión del 17:00 31 ago 2022
Línea 15:		Línea 15:

	==Clinical Features==		==Clinical Features==
	*Escalation behaviors include progression through:		*Escalation behaviors may include progression through:
	**~~anger~~, resistance, aggression, hostility, argumentativeness, violence		**Anger, resistance, aggression, hostility, argumentativeness, violence

	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1: /* Differential Diagnosis */

2022-08-31T16:08:48Z

Differential Diagnosis

← Revisión anterior		Revisión del 16:08 31 ago 2022
Línea 19:		Línea 19:

	==Differential Diagnosis==		==Differential Diagnosis==
	*FIND ME (functional, infectious, neurologic, drugs, metabolic, endocrine)		''FIND ME (functional, infectious, neurologic, drugs, metabolic, endocrine)''
	*Psychiatric		*Psychiatric
	**[[Schizophrenia]], paranoid ideation, catatonic excitement		**[[Schizophrenia]], paranoid ideation, catatonic excitement

Rossdonaldson1: Rossdonaldson1 moved page Combative patient to Agitated or combative patient

2022-08-31T15:36:12Z

Rossdonaldson1 moved page Combative patient to Agitated or combative patient

← Revisión anterior	Revisión del 15:36 31 ago 2022
(Sin diferencias)

Rossdonaldson1: /* See Also */

2022-08-31T15:35:14Z

Dwristers: /* Evaluation */

2022-06-17T09:20:17Z

Evaluation

← Revisión anterior		Revisión del 09:20 17 jun 2022
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	***Metabolic panel: serum electrolytes, thyroid function		***Metabolic panel: serum electrolytes, thyroid function
	***Toxicology screen and blood alcohol levels		***Toxicology screen and blood alcohol levels
			***Ammonia level
			***Urine analysis
	***[[Lumbar puncture]] (CNS infection)		***[[Lumbar puncture]] (CNS infection)
	***Aspirin and acetaminophen levels (intentional ingestion)		***Aspirin and acetaminophen levels (intentional ingestion)

← Revisión anterior		Revisión del 15:35 31 ago 2022
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	==See Also==		==See Also==
			*[[Sedation (main)]]
	*[[Altered mental status]]		*[[Altered mental status]]
	*[[Excited delirium]]		*[[Excited delirium]]
	*[[~~Sedation (main)~~]]		*[[Acute psychosis]]

	==External Links==		==External Links==