Course Credit: 1 hour
Treatment of overtly agitated, violent, or psychotic patients in the emergency department is challenging as clinicians often lack information about patients’ past medical and psychiatric history. Further, an agitated patient’s behavior may hinder the ability to perform a clinical examination. When presented with this scenario, verbal de-escalation should be trialed along with easy-to-administer oral medications.1 However, when these low-risk strategies fail, more potent pharmacologic sedation and physical restraints may be required.2 The ultimate decision to pursue pharmacologic sedation is a clinical one with the goal of calming the patient without oversedation so that he/she can take part in the plan of care without compromising diagnostic efforts or causing harm. This Capsules module will discuss the pharmacologic background of various agents used in the treatment of the agitated patient.
Learning Objectives
- Describe pharmacokinetic properties of medications routinely used to treat acute agitation
- Identify potential adverse effects associated with first- and second-generation antipsychotics
- Evaluate the comparative efficacy between various pharmacologic agents for treatment of acute agitation
- Recognize potential challenges of pharmacologic sedation in special populations
| Authors | Affiliation | |
|---|---|---|
| Jenny Koehl, PharmD, BCPS | Emergency Medicine Clinical Pharmacist, Massachusetts General Hospital | @jlkoehl |
| Kyle DeWitt, PharmD, BCPS | Emergency Medicine Clinical Pharmacist, University of Vermont Medical Center | @EmergPharm |
| Gabrielle L. Procopio, PharmD, BCPS | Emergency Medicine Clinical Pharmacist, Hackensack University Medical Center | @gppharmed |
| Zlatan Coralic, PharmD, BCPS | Emergency Medicine Clinical Pharmacist, University of California – San Francisco | @ZEDpharm |
| Editors | Affiliation | |
|---|---|---|
| Emily Wiener, PharmD | Emergency Medicine Clinical Pharmacist, Baltimore Washington Medical Center | @PharmdEMily |
| Xander Miller, PharmD | PGY-1 Pharmacy Resident, Massachusetts General Hospital | @XanderBOS |
| Bryan Hayes, PharmD, FAACT, FASHP (Lead Editor) | Emergency Medicine Clinical Pharmacist, Massachusetts General Hospital | @PharmERToxGuy |
great series!…like to see a procedural sedation module
Under the special population section for acute agitation in a pregnant patients the listed second line agent is recommended to be BENZO’s.
This is category D.
I understand riks/ benefit but this really boxes us in to use this agent.
Any comment/advice?
Thx for nice review/discussion on topic.
Thank you for your comment, Paul. Benzodiazepines are second line agents and as a one time dose amniotic/fetal levels are not likely to reach a significant enough level to pose harm.