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Agitated Violent Patients

Vanessa Cardy, MD and Mel Herbert, MD MBBS FAAEM

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Crunch Time EM - Psych - Written Summary 218 KB - PDF

Agitated Violent Patients

Vanessa Cardy MD and Mel Herbert MD

  • Safety = first priority
    • Yourself, ED staff, the patient, other patients
  • Ways to avoid escalation of violent behaviour
    • Verbal redirection
    • Secure environment
      • Alone in safe room
      • No access to dangerous objects
      • No access to own belongings
  • Restraints if necessary to protect patient and staff
    • Close monitoring and frequent reassessment for ALL restrained patients
    • Chemical restraints (calming agents), often administered IM because IV can be dangerous to place
      • Antipsychotics
      • Benzodiazepines
        • Can combine into single injection, +/- diphenhydramine
      • Ketamine for agitated delirium, violent patients, or failed to calm after multiple doses of antipsychotics and benzos
    • Physical Restraints
      • Requires close monitoring and position changes
      • Secure all 4 extremities, as tying the patient partially is more dangerous
  • Assess patient properly to rule out underlying organic cause
    • Consider hypoxia, hypoglycemia, CNS trauma or infection, intoxication, toxidrome

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Psych Full episode audio for MD edition 56:27 min - 78 MB - M4ACrunch Time EM - Psych - Individual MP3 Files 99 MB - ZIPCrunch Time EM - Psych - Written Summary 218 KB - PDF

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