II. Definitions

  1. Agitation
    1. Behavior that is loud, hyperactive, disruptive, threatening or disruptive
  2. Agitated Delirium (Excited Delirium)
    1. Psychomotor Agitation, Delirium and sweating often with Violent Behavior, increased strength, hyperthermia

III. Precautions

  1. See Agitated Delirium
  2. Patient Agitation is highly dangerous for both patients and staff
    1. Assaults by patients against nurses and physicians in the Emergency Department is common
      1. Schnapp (2016) West J Emerg Med 17(5): 567-73 [PubMed]
      2. Omar (2018) Ann Emerg Med 72(4): s144 [PubMed]
    2. Follow established protocols for deescalation, Physical Restraint and Sedation of the Violent Patient
      1. Employ acute intensive management to prevent injury to patients and staff
    3. Agitation is frequently associated with secondary causes (see below) as well as injuries (e.g. Closed Head Injury)
      1. Ensure patient and staff safety, and then evaluate red flags (see below)
      2. Psychiatric causes of acute Agitation are a diagnosis of exclusion
  3. Red Flags for Underlying Medical Causes
    1. See Delirium
    2. Extremes of age (young children, elderly)
    3. Abnormal Vital Signs (e.g. fever, significant Tachycardia, Hypoxia)
    4. Trauma
    5. Delirium
    6. Visual Hallucinations
    7. Neurologic Abnormalities
    8. Acute Intoxication
    9. Unknown Ingestion
    10. Signs of Substance Withdrawal
    11. Serious comorbidities (e.g. Immunosuppression)
    12. Lack of prior mental illness

V. History

  1. Review medical record including recent emergency visits and hospitalizations
  2. Obtain history from EMS staff on arrival
  3. Obtain history from family

IX. References

  1. Roppolo, Klinger, Leaf (2019) Crit Dec Emerg Med 33(2): 3-10
  2. Shanks, Ginsburg and Leaf (2023) Crit Dec Emerg Med 37(9): 4-10

Images: Related links to external sites (from Bing)

Related Studies