Adult Out-of-Hospital or Emergency Department Patients Presenting With Severe Agitation

Publication Date: October 11, 2023
Last Updated: October 12, 2023

Summary of Recommendations

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. (B)
334012
For efficacious treatment of severe agitation in the emergency department, use the above agents as described or haloperidol alone or in combination with lorazepam. (B)
334012
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) (C)
334012
No recommendations for or against the use of specific agents in the out-of-hospital setting can be made at this time. (Consensus) (C)
334012
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) (C)
334012

Recommendation Grading

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Overview

Title

Evaluation and Management of Adult Out-of-Hospital or Emergency Department Patients Presenting With Severe Agitation

Authoring Organization

Publication Month/Year

October 11, 2023

Last Updated Month/Year

November 6, 2023

Document Type

Guideline

Country of Publication

US

Document Objectives

This clinical policy from the American College of Emergency Physicians addresses key issues in the evaluation and management of adult out-of-hospital or emergency department patients presenting with severe agitation. A writing subcommittee conducted a systematic review of the literature to derive evidence-based recommendations to answer the following clinical question: 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? Evidence was graded, and recommendations were made based on the strength of the available data.

Target Patient Population

Adults with undifferentiated severe agitation who require immediate sedation to facilitate life-saving medical care

Target Provider Population

Physicians working in emergency departments and allied providers caring for patients in EDs

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Emergency care, Hospital

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Counseling, Assessment and screening, Management

Diseases/Conditions (MeSH)

D004635 - Emergency Medicine, D011595 - Psychomotor Agitation, D004630 - Emergencies, D004638 - Emergency Treatment

Keywords

Agitation, Emergency Department

Methodology

Number of Source Documents
47
Literature Search Start Date
June 18, 2021
Literature Search End Date
February 2, 2022