Agitation is a common presentation in alcohol-intoxicated patients. When agitation is accompanied by psychomotor restlessness or violent behaviour, it places both the patient and clinical staff at significant risk of harm and warrants prompt, structured intervention.
Verbal de-escalation is the recommended first-line approach for agitation in alcohol intoxication, unless the patient is actively violent or poses an imminent threat. This protocol addresses the situation where verbal de-escalation has been attempted and resolution of agitation has not been achieved.
When verbal de-escalation is insufficient, pharmacologic treatment is indicated. The approach draws on antipsychotics, benzodiazepines, or an intramuscular combination of both — the full selection criteria, sequencing, and decision framework are available in the complete protocol.
Adequate sedation with resolution of agitation.
DOI: 10.1016/j.jemermed.2023.01.010
Agitation is a common component of encounters for AI.
Agitation, particularly when associated with psychomotor activity or violence, puts the patient and staff at significant risk for morbidity, and thus warrants prompt treatment.
If verbal de-escalation is not successful and the AI patient remains agitated, medications to treat agitation should be utilized.
Intramuscular combination of a benzodiazepine and an antipsychotic allows for lower doses of each medication, which may mitigate side effects associated with larger doses of either.
Commonly used combinations are 5 mg of i.m. midazolam or 2 mg of lorazepam with 5 mg of droperidol, olanzapine, or haloperidol.
Intramuscular olanzapine, droperidol, and ziprasidone have more rapid onset and result in adequate sedation more often compared with haloperidol, though ziprasidone has a slower onset than olanzapine and droperidol.
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