Acute Behavioural Disturbance

Question 1

What are some potential/correctable causes of agitation? (10 things)

Answer 1

• Head injury
• Infection/Sepsis
• Metabolic derangement
• Hypoxia
• Hypoglycaemia
• Post ictal
• Alcohol withdrawal syndrome
• Exposure to toxins
• Drug induced hyperthermia
• Unmet needs (Pain)

Question 2

What needs to be completed prior to administering parenteral sedation?

Answer 2

• Sedation checklist

Question 3

What is the Management for Mild to Moderate Agitation?

Answer 3

Olanzapine ODT
- 10mg repeat after 20 minutes further 10mg
- Frailty/intoxicated/maintanence dose 5mg Repeat after 20minutes 5mg

Question 4

What is the Management for Moderate to Severe agitation

Answer 4

Droperidol (preferred)
- 10mg repeat after 15minutes (if required, once only)
- 5mg repeat after 15minutes (Frail/elderly/intoxicate/maintenance dose)

Midazolam
- 5 - 10mg (Repeat after 10minutes)
- 2.5 - 5mg (Frail/elderly/intoxicated/maintenance dose) repeat after 10minutes

Question 5

What is the management for an extreme safety risk

Answer 5

• Request MICA
  Ketamine
• 200mg for <60kg
• 300mg for 60-90kg
• 400mg for >90kg

Question 6

For severe agitation what is the IV dose of Midazolam?

Answer 6

2.5 - 5mg
- Repeat 2.5 - 5mg at 5minute intervals
OR
1 - 2mg (Frail/Elderly/Intoxicated)
- repeat at 5minute intervals
- Total dose 20mg

Question 7

What are the care objectives of acute behavioural disturbance

Answer 7

• Maintain environment for patients, staff, other emergency responders, family and bystanders
• Use the least restrictive means possible, maintaining verbal and environmental de-escalation strategies throughout the interaction
• Consider clinical causes of acute behavioural disturbance