Pharmacy & Acute Care University
Pharmacy & Acute Care University
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Management of Acute Agitation in the Emergency Department

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  1. Background
  2. Evaluation

  3. Management

    Non-Pharmacologic Management
  4. Benzodiazepines
  5. First Generation Antipsychotics
  6. Second Generation Antipsychotics
  7. Disease State Considerations
  8. Droperidol
  9. Ketamine

Participants 426

  • Allison Clemens
  • April
  • ababaabhay
  • achoi2392
  • adhoward1
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Therapeutic Goals

The assumption of this presentation is that verbal de-escalation and oral medications have already been attempted if safe to do so!

Overuse of IM medication can damage patient-provider relationships and mask underlying conditions

Things that are helpful…

  • Ask if willing to take medications by mouth
    • Oral disintegrating tablets – olanzapine (Zyprexa Zydis), risperidone (Risperdal M-tab)
  • Offer food, blankets, water
  • Listen to what the patient is saying and acknowledge their feelings
  • Offer optimism and options

De-escalation techniques

  • Verbal and nonverbal de-escalation techniques 
  • Ten domains of de-escalation that help clinicals take care of agitated patients
10 domains of de-escalation 
1. Respect personal space
2. Do not be provocative 
3. Establish verbal contact 
4. Be concise
5. Identify wants and feelings  
6. Listen closely to what the patient is saying
7. Agree or agree to disagree 
8. Lay down the law and set clear limits
9. Offer choices and optimism 
10. Debrief the patient and staff