Rapid tranquilisation

Question 1

What is the first step if tranquilisation is required

Answer 1

De-escalation
- Maintain adequate distance
- Ensure environment is safe, move to a safe place if needed
- Used non-threatening language, be aware of non-verbal communication
- converse and try to develop a therapeutic relationship with the patient throughout

Question 2

What is the pharmacological approach to rapid tranquilisation in those who are neuroleptic naive/unknown

Answer 2

First line: ORAL lorazepam (allow for 1 hour)
Second line: IM lorazepam (wait 30 minutes)
Third line: IM olanzapine / haloperidol with promethazine OR lorazepam

Question 3

What is the pharmacological approach to rapid tranquilisation in those who have a Hx of antipsychotic use

Answer 3

First line: ORAL lorazepam OR olanzapine OR haloperidol OR promethazine
Second line: IM haloperidol with promethazine OR lorazepam (wait 30 minutes then repeat)
Third line: IM lorazapem OR olanzapine

If Hx cardiac disease: olanzapine used second line

Question 4

What should be done after rapid tranquilisation

Answer 4

Monitor: hourly for oral, every 15 mins for IM
Seek advice from senior
Review medications
Document as incident