Acute Behavioural Disturbance

Question 1

When is it safe to assume Acute Behavioural Disturbance is caused by a medical disorder

Answer 1

Age >45
abnormal vital signs
Disorientation
Loss of or altered consciousness

Question 2

What agent is most appropriate for medical causes of Acute Behavioural Disturbance?

Answer 2

Midazolam

Question 3

When treating a patient who is demonstrating an Acute Behavioural Disturbance what must be completed and documented?

Answer 3

Mental State Examination

Question 4

If parenteral sedation is required for patients over 65 experiencing an Acute Behavioural Disturbance, what is the preferred first-line agent?

Answer 4

Droperidol

Question 5

What is the preferred agent in patients experiencing secondary-psychosis?

Answer 5

Midazolam

Question 6

Management of patients 16-64 with an Acute Behavioural Disturbance?

Answer 6

Lorazepam: 1-3mg up to a max of 4mg 30 mins apart
OR
Olanzapine: 5-10mg 30 mins apart to a max of 20mg in 24 hours

Question 7

When should we give Droperidol to an Acute Behavioural Disturbance and at what dosage 16-64?

Answer 7

If SAT >+2 and non-medical cause
IM droperidol 5-10mg, repeat after 15 mins if still SAT max >+2
max 20mg in 24 hours
IV Droperidol 2.5mg-5mg repeat every 5-15 mins to max of 20mg in 24 hours

Question 8

When should we give Midazolam to an Acute Behavioural Disturbance and at what dosage 16-64?

Answer 8

If SAT >+2 and suspected medical cause or droperidol ineffective
IM Midazolam 50mcg/kg to 5mg single dose and repeat every 5 mins to max 10mg
IV Midazolam 1mg every 5 mins up to 3mg

Question 9

Management of patients 8-15 with an Acute Behavioural Disturbance?

Answer 9

Oral Lorazapam 0.5-1mg to max dose of 4mg
CONSULT oral Olanzapine 2.5mg-5mg
If SAT >+2
IM Midazolam 50mcg/kg to 5mg with a max dose of 200mcg/kg
OR
IV Midazolam 1mg slow push in 0.5mg increments, every 5 mins to a max of 200mcg/kg
CONSULT IM Droperidol 0.1-0.2mg/kg to single max dose 10mg