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Scope of Application.
This guideline is intended for physicians working in emergency departments (EDs).
Inclusion Criteria.
This guideline is intended for adults with undifferentiated severe agitation who require immediate sedation to facilitate life-saving medical care.
Exclusion Criteria.
This guideline is not intended for pediatric, pregnant, or out-of-hospital patients or patients above the age of 65.
Recommendations offered in this policy are not intended to represent the only diagnostic and management options that the emergency physician should consider. ACEP recognizes the importance of the individual physician’s judgment and patient preferences.
Is there a superior parenteral medication or combination of medications for the acute management of adult out-of-hospital or emergency department patients with severe agitation?
None specified.
For more rapid and efficacious treatment of severe agitation in the emergency department, use a combination of droperidol and midazolam or an atypical antipsychotic in combination with midazolam. If a single agent must be administered, use droperidol or an atypical antipsychotic due to the adverse effect profile of midazolam alone.
For efficacious treatment of severe agitation in the emergency department, use the above agents as described or haloperidol alone or in combination with lorazepam.
In situations where safety of the patient, bystanders, or staff is a concern, consider ketamine (intravenous or intramuscular) to rapidly treat severe agitation in the ED (Consensus recommendation).
No recommendations for or against the use of specific agents in the out-of-hospital setting can be made at this time (Consensus recommendation).
No recommendation for or against the use of specific agents in patients above the age of 65 years can be made at this time (Consensus recommendation).
None specified.
For more rapid and efficacious treatment of severe agitation in the emergency department, use a combination of droperidol and midazolam or an atypical antipsychotic in combination with midazolam. If a single agent must be administered, use droperidol or an atypical antipsychotic due to the adverse effect profile of midazolam alone.
For efficacious treatment of severe agitation in the emergency department, use the above agents as described or haloperidol alone or in combination with lorazepam.
In situations where safety of the patient, bystanders, or staff is a concern, consider ketamine (intravenous or intramuscular) to rapidly treat severe agitation in the ED (Consensus recommendation).
No recommendations for or against the use of specific agents in the out-of-hospital setting can be made at this time (Consensus recommendation).
No recommendation for or against the use of specific agents in patients above the age of 65 years can be made at this time (Consensus recommendation).
