Agitation in an Alcohol-Intoxicated Patient: When Antipsychotics or Benzodiazepines Have Not Achieved Adequate Sedation

Clinical Scenario

Agitation is a common feature of alcohol intoxication encounters. When accompanied by psychomotor agitation or violent behaviour, it places both the patient and clinical staff at significant risk of harm, making prompt and effective management essential.

Previous Line — Inadequate Response

Standard pharmacologic treatment of agitation — with antipsychotics (haloperidol, droperidol, olanzapine, ziprasidone, or risperidone), benzodiazepines (midazolam, lorazepam, or diazepam), or an intramuscular combination of both — has not achieved adequate sedation with resolution of agitation. This protocol is the next step.

Next-Step Approach

This protocol involves a dissociative agent given under procedural-sedation-level monitoring, with an airway-capable clinician available at the bedside.

Full agent selection, route, dose, and monitoring requirements are detailed in the structured regimen below.

Instant Access to Structured Evidence-Based Regimens

References

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.

For agitated patients who are uncontrollably violent with concern for immediate harm to self or others, or if there is a concern for an immediately life-threatening medical condition whose diagnosis and management is hindered by agitation, dissociative-dose ketamine (4–5 mg/kg i.m. or 1–2 mg/kg i.v.) should be considered.

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