Guidelines for Managing Agitated Patients in the ED

Proper management of agitated patients presenting to the ED is essential to keeping staff safe and ensuring appropriate care. In many cases, agitation cases can be managed with non-pharmacologic methods, but medications are becoming increasingly important in acute agitation in EDs. In the February 2012 Western Journal of Emergency Medicine, my colleagues and I at the American Association for Emergency Psychiatry published consensus recommendations on best practices for using medication to manage agitated patients in emergency settings. Rationale & Goals When Calming Patients Non-pharmacologic approaches—verbal de-escalation, quieting the room, and dimming the lighting—should be attempted before medications are administered. When initial verbal methods fail to calm patients, medication may be necessary. Clinicians should make a provisional diagnosis on the likely cause of the agitation because this can help guide medication choices. In many cases, agitation increases over time during ED treatment. By intervening early, to preempt the potential escalation of agitation to severe and dangerous levels, it may be possible to include patients in the medication decision process and use lower doses. The goal of using medication in agitated patients is to calm them without inducing sleep. Excessive sedation may interfere with assessment and treatment of underlying conditions. To the extent possible, medications should be used that specifically target the cause of agitation based on the provisional diagnosis. “The goal of using medication in agitated patients is to calm them without inducing sleep.” No class of medication is considered “best” in all cases of agitation, but three drug classes have been studied and used most frequently, including first- and second-generation antipsychotics and benzodiazepines. Although these drugs may manage acute...