AGITATED PATIENT

Question 1

Etiology

Answer 1

Alcohol intoxication / withdrawal, Stimulant intoxication

Infection (encephalitis?)

Hypoxemia (MC), Hypoglycemia, Hyper or Hypothermia

Stroke, Seizure, Dementia

Psychosis, Mania, Antisocial personality disorder

Question 2

4 screening criteria suggesting organic etiology for agitation

Answer 2

Disorientation
Abnormal vitals
Fluctuating level on consciousness
No previous psychiatric history

Question 3

Risk Factors for Violence

Answer 3

Male
Acute intoxication
Acute mania
Prior history of violence

Question 4

Stepwise approach to dealing with the agitated patient

Answer 4

1. Verbal De-escalation
2. Physical Restraints
3. Chemical Restraints

Question 5

Benzodiazepines: Dosing, ADRs

Answer 5

Lorazepam 1-2 mg IV/IM q 30 min PRN
Fast acting, short half life, safe in liver disease

Midazolam 2-5 mg IV/IM q 15 min PRN
Shorter half life than lorazepam

ADRs: sedation, confusion, ataxia, respiratory depression
Beware when using with alcohol

Question 6

Haloperidol: Dosing, Typical Starting dose, ADRs

Answer 6

Dosing:
2-10 mg IV/IM q20-30 min PRN
Max 6 doses in 24 hrs

Typical Starting dose: 5 mg IV
1-2 mg in elderly

ADRs:
Avoid in anticholinergic intoxication, sympathomimetic toxidrome
EPS (dystonia, akathisia) can occur in a single dose
NMS
Cardiac Dysrhythmias can occur to QT prolongation - avoid in elderly and cardiac history