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Chapter 22 - Use ofagitation treatment in the emergency department

from Section 4. - Treatment of the psychiatric patient

Published online by Cambridge University Press:  05 April 2013

By
Marc L. Martel ,
Amanda E. Horn  and
William R. Dubin
Edited by
Leslie S. Zun
Edited in association with
Lara G. Chepenik  and
Mary Nan S. Mallory
Leslie S. Zun
Affiliation:
Department of Emergency Medicine, Mt Sinai Hospital, Chicago
Lara G. Chepenik
Affiliation:
Yale University School of Medicine
Mary Nan S. Mallory
Affiliation:
University of Louisville, School of Medicine
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Summary

Emergency physicians are frequently required to care for unknown patients with acute undifferentiated agitation. Agitation is known to be associated with several other psychiatric and medical causes. Agitation, regardless of the etiology, is a behavioral emergency. Both typical (first-generation) and atypical (second-generation) antipsychotics are frequently used in the management of agitation. Several of the typical antipsychotics have been associated with QT prolongation and torsades de pointes. Other acute adverse effects of antipsychotic use in the treatment of acute agitation include anticholinergic effects, movement disorders, and neuroleptic malignant syndrome. Benzodiazepines are commonly used in the acute management of agitation. In addition to rapid sedation, ketamine's short duration of action, parenteral administration, and in particular the preservation of protective airway reflexes, are attractive properties in the management of patients with acute agitation. According to the Joint Commission Standards, restraints can only be used when clinically justified or when warranted by patient behavior.

Keywords

Mini-Mental State Examinationneuropsychiatric syndromedeliriumdementiaemergency departmentpharmacologyConfusion Assessment MethodAlzheimer's diseasecognitive assessment
Type
Chapter
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Behavioral Emergencies for the Emergency Physician , pp. 164 - 169
Publisher: Cambridge University Press
Print publication year: 2013

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