Management of the agitated patient in the emergency department

Fernández Gallego V, Murcia Pérez E, Sinisterra Aquilino J, Casal Angulo C, Gómez Estarlich MC

Agitated patients must be managed fairly often in routine emergency department

practice. After safety measures are taken during initial assessment, a tentative diagnosis

based on the cause of agitation (physical condition, underlying mental disorder, or

extreme anxiety) should be made. That diagnosis will facilitate possible resolution of the

problem through dialog with the patient or through physical restraint. If restraint is

chosen, the manner of proceeding should be planned and at least 5 persons should be

involved. The restraining maneuver is usually followed by administration of

benzodiazepines, neuroleptic agents, or a combination of both in order to assure

sedation. It is important to remember that these patients pose a threat to their families,

emergency room staff, and themselves; therefore, they are candidates for voluntary or

involuntary admission to a psychiatric unit. If that is the course of action chosen,

admission must comply with the law and adequate restraint and sedation should be

prescribed. All such actions should be recorded in the emergency department’s report to

the psychiatrist on duty, who will be the admitting physician.

Casal-Angulo C, Fernández Gallego V, Gómez Estarlich MC, Murcia Pérez E, Sinisterra Aquilino J