Agitated Patients

Question 1

Definition

Answer 1

Acute cognitive dysfunction secondary to a medical condition

Question 2

Goal of Care

Answer 2

Recognition of altered mental status; look for reversible causes and provide safe transport

Question 3

Cues

Answer 3

• Restlessness
• Extreme physical or mental excitement
• Delirious pts rarely are able to negotiate and cooperate w/ caregivers
• Irrational or inappropriate behaviour

Question 4

Causes

Answer 4

Life Threatening Condition:

• Hypoxia
• Hypoglycemia
• Head inj
• Drug actions or withdrawal
• Infection (pneumonia, sepsis)
• Electrolyte imbalances

Other common causes:

• Alcohol or recreational drug intoxication
• Endorcrine (DKA, hypo/hyperthyroidism)

Question 5

Guiding Principles

Answer 5

Pts who are extremely agitated w/ an alteration of cognitive function, including those w/ hypoglycemia are at risk of irreversible cardioplmonary arrest

Sedation may permit a safer transport and provide an earlier opportunity for hospital staff to evaluate the pt.

IM Ketamine is the preferred drug to gain medical control in severe agitation / ExDS due tot its faster onset, shorter duration, improved efficacy and fewere significant side effects

Record pre and post RASS scores

Question 6

Special Note

Answer 6

Sudden death in excited delirium has been associated w/ pts restrained face down. If it is necessary to place the pt prone initially to gain control, monitor the airway and vital signs losely and lways move to a supine or 3/4 prone position as soon as possible

Question 7

Intervention Guidelines

Answer 7

• Await police restraint if indicated
• Position pt 3/4 prone
• Monitor vital signs, including temperature
• Supplemental O2
• Correct suspected or confirmed hypoglcemia
• Glucogel - 1 pacakge

PCP
Correct hypoglycaemia
- Glucagon 1mg IM
- Dextrose 10-25g D10W IV