Episode 197: Acute Agitation

Acute agitation in the emergency department is examined, emphasizing the importance of moving beyond stigmatized terms and focusing on severity and underlying causes. Initial assessment involves gauging agitation levels, considering reversible causes, and forming a differential diagnosis. Rapid treatment is crucial for severely agitated patients to mitigate risks of self-injury, harm to staff, and emergent medical conditions like rhabdomyolysis. The discussion highlights verbal de-escalation techniques, including ensuring safety, building a therapeutic alliance, and offering choices. Pharmacologic interventions, such as oral medications (antipsychotics and benzodiazepines), are considered, alongside intramuscular or intravenous options like droperidol, midazolam, haloperidol, and ketamine, weighing their respective benefits and risks. Special considerations for elderly, pediatric, and autism spectrum disorder patients are also addressed.