![]() If medication is required to manage agitation, administering drugs either PO or IV may be perceived as less threatening or traumatic by patients. With this in mind, it is important to know the risks and benefits of various classes of medications frequently used for agitation in the Emergency Department. ![]() Certain patient factors were found to increase the odds of an adverse event, including age 65 or older, multiple sedative administrations within 60 minutes, and alcohol intoxication. In one Australian study, 15.9% of patients experienced a sedation related adverse event.5 These were most commonly hypoxia, airway obstruction, QTc prolongation, bradycardia, and hypotension. However, sedation related adverse events are somewhat common. Studies have reported that sedation is given for agitation in 3-20 of every 1000 ED visits. Some patients with agitation will require medication mediated sedation for safety and to facilitate medical evaluation. In the case of pediatric patients, providers should take note whether family members are calming or exacerbating the child’s agitation, and steps can be taken to further involve family or separate as necessary. If these interventions are unsuccessful, a show of force can be utilized with the help of security staff, with a provider-led team when possible. Noise and other distractions should be minimized as much as possible in the busy ED environment, and the patient may be provided with food, blankets, and other comfort items. Verbal de-escalation should first be attempted, including re-orientation and successive attempts at a therapeutic alliance. NON-PHARMOCOLOGIC DE-ESCALATION TECHNIQUESįirst-line interventions for acute agitation should utilize non-medication based techniques to de-escalate the situation. All agitated patients should immediately have a POC glucose performed, and all women of child-bearing age should have a pregnancy test. Though psychiatric illness can be associated with presentation of acute agitation, experts reinforce that new onset agitation in a patient without clear history of psychiatric disease should be presumed to be from a medical etiology until shown otherwise. Agitation needs to be recognized quickly by ED personnel and managed while taking into account likely predisposing factors for each patient as well as co-morbidities. The treatment of agitation in the ED can protect patients and staff from harm as well as allow a medical workup to proceed in order to identify any underlying medical cause. The American Association for Emergency Psychiatry BETA project defines agitation as “an extreme form of arousal that is associated with increased verbal and motor activity.” Patients who are acutely agitated can pose risk to themselves as well as staff. Acute agitation is a common presentation in the Emergency Department, with some studies citing that this accounts for 2.6% of total patient encounters.
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