How to Sedate the Violent Patient

​The emergency department can be an exciting yet sometimes violent place to work, often because of a patient presenting with excited delirium syndrome (ExDS), the most severe form of agitation. It is associated with the use of sympathomimetics such as methamphetamine, cocaine, and PCP.​Patients with ExDS present with sudden onset of aggressive and bizarre behavior. These patients generally demonstrate unexpected physical strength and hyperthermia. This disease process is extremely important for prehospital responders and emergency physicians to recognize because almost two-thirds of the patients with ExDS die at the scene or during transport. (West J Emerg Med 2011;12[1]:77.) Death is generally due to hyperthermia, rhabdomyolysis, or multiorgan failure. Several medications can be used to sedate these patients.KetamineIntramuscular ketamine has become increasingly popular in the prehospital setting for chemical sedation of agitated patients due to its rapid onset of action and wide therapeutic window. The use of ketamine has been described to be safe and effective in the prehospital setting, and appears to have minimal side effects. (West J Emerg Med 2014;15[7]:736; Prehosp Emerg Care 2013;17[2]:274.)The recommended dose is 4-5 mg/kg IM. IM ketamine has the most rapid onset of sedation (three minutes or less), and it acts as an analgesic. There appears to be a positive association between higher incidence of intubation and increasing doses of ketamine. (Am J Em...
Source: The Tox Cave - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs