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Pharmacologic Therapy to Mitigate Acute Agitation in the Emergency Department: Case Reports of Diverse Patient Presentations

Published:December 31, 2022DOI:https://doi.org/10.1016/j.jen.2022.12.005

      Abstract

      Nurses in the emergency department often encounter patients exhibiting signs of aggressive behavior. Nurses need to know the pharmacologic treatment appropriate for the patient scenario to ensure safety for the patient and the emergency department team. This case review examines 4 common scenarios where a patient exhibits aggressive behavior. After each case review is a discussion about the appropriate pharmacologic therapy for that patient. The cases portrayed are fictional but based on experience and previous observations.

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      References

        • Muir-Cochrane E.
        • Oster C.
        • Gerace A.
        • Dawson S.
        • Damarell R.
        • Grimmer K.
        The effectiveness of chemical restraint in managing acute agitation and aggression: a systematic review of randomized controlled trials.
        Int J Ment Health Nurs. 2020; 29: 110-126https://doi.org/10.1111/inm.12654
        • Attilia F.
        • Perciballi R.
        • Rotondo C.
        • et al.
        Alcohol withdrawal syndrome: diagnostic and therapeutic methods.
        Riv Psichiatr. 2018; 53: 118-122https://doi.org/10.1708/2925.29413
        • Wilson M.P.
        • Pepper D.
        • Currier G.W.
        • Holloman Jr., G.H.
        • Feifel D.
        The psychopharmacology of agitation: consensus statement of the American Association for emergency psychiatry project Beta psychopharmacology workgroup.
        West J Emerg Med. 2012; 13: 26-34https://doi.org/10.5811/westjem.2011.9.6866
        • Stetson S.R.
        • Osser D.N.
        Psychopharmacology of agitation in acute psychotic and manic episodes.
        Curr Opin Psychiatry. 2022; 35: 171-176https://doi.org/10.1097/YCO.0000000000000787
        • Wilson M.P.
        • Chen N.
        • Vilke G.M.
        • Castillo E.M.
        • MacDonald K.S.
        • Minassian A.
        Olanzapine in ED patients: differential effects on oxygenation in patients with alcohol intoxication.
        Am J Emerg Med. 2012; 30: 1196-1201https://doi.org/10.1016/j.ajem.2012.03.013
        • Bergman H.
        • Rathbone J.
        • Agarwal V.
        • Soares-Weiser K.
        Antipsychotic reduction and/or cessation and antipsychotics as specific treatments for tardive dyskinesia.
        Cochrane Database Syst Rev. 2018; 2: CD000459https://doi.org/10.1002/14651858.CD000459
        • Oh E.S.
        • Fong T.G.
        • Hshieh T.T.
        • Inouye S.
        Delirium in older persons: advances in diagnosis and treatment.
        JAMA. 2017; 318: 1161-1174https://doi.org/10.1001/jama.2017.12067
        • Pietro G.
        • De Fazio P.
        • Manfredi V.G.
        • De Sarro G.
        Use and safety of antipsychotics in behavioral disorders in elderly people with dementia.
        J Clin Psychopharmacol. 2014; 34: 109-123https://doi.org/10.1097/JCP.0b013e3182a6096e
        • Maeda I.
        • Inoue S.
        • Uemura K.
        • et al.
        Low-dose trazodone for delirium in patients with cancer who received specialist palliative care: a multicenter prospective study.
        J Palliat Med. 2021; 24: 914-918https://doi.org/10.1089/jpm.2020.0610
        • Thiemann P.
        • Roy D.
        • Huecker M.
        • et al.
        Prospective study of haloperidol plus lorazepam versus droperidol plus midazolam for the treatment of acute agitation in the emergency department.
        Am J Emerg Med. 2022; 55: 76-81https://doi.org/10.1016/j.ajem.2022.02.042
        • Klein L.R.
        • Driver B.E.
        • Miner J.R.
        • et al.
        Intramuscular midazolam, olanzapine, ziprasidone, or haloperidol for treating acute agitation in the emergency department.
        Ann Emerg Med. 2018; 72: 374-385https://doi.org/10.1016/j.annemergmed.2018.04.027
        • Djerroud L.
        • Leclair G.
        • Sullivan T.
        • Dagenais-Beaulé V.
        Visual compatibility and particle counter evaluations of syringes of intramuscular psychotropic coadministered solutions.
        Eur J Hosp Pharm. 2022; (ejhpharm-2022-003378)https://doi.org/10.1136/ejhpharm-2022-003378
        • Gibler B.
        • Kim M.S.
        • Raleigh F.
        Visual compatibility of neuroleptics with anticholinergics or antihistamines in polyethylene syringes.
        Am J Hosp Pharm. 1994; 51: 2709-2710
        • Gottlieb M.
        • Long B.
        • Koyfman A.
        Approach to the agitated emergency department patient.
        Clin Rev Emerg Med. 2016; 54: 447-457
        • Roppolo L.P.
        • Morris D.W.
        • Khan F.
        • et al.
        Improving the management of acutely agitated patients in the emergency department through implementation of Project BETA (Best Practices in the Evaluation and Treatment of Agitation).
        J Am Coll Emerg Phys Open. 2020; 1: 898-907https://doi.org/10.1002/emp2.12138
        • Miner J.R.
        • Klein L.R.
        • Cole J.B.
        • Driver B.E.
        • Moore J.C.
        • Ho J.D.
        The characteristics and prevalence of agitation in an urban county emergency department.
        Ann Emerg Med. 2018; 72: 361-370https://doi.org/10.1016/j.annemergmed.2018.06.001
        • Liu J.
        • Gan Y.
        • Jiang H.
        • et al.
        Prevalence of workplace violence against healthcare workers: a systematic review and meta-analysis.
        Occup Environ Med. 2019; 76: 927-937https://doi.org/10.1136/oemed-2019-105849
        • Aljohani B.
        • Burkholder J.
        • Tran Q.T.
        • Beisenova K.
        • Pourmand A.
        • Pourmand A.
        Workplace violence in the emergency department: a systematic review and meta-analysis.
        Public Health. 2021; 196: 186-197
      1. Workplace violence. Emergency Nurses Association.

      Biography

      Tonya Rutherford-Hemming is Clinical Nurse IV, Heart of Carolina Chapter ENA, Emergency Department, University of North Carolina Healthcare, Chapel Hill, NC. ORCID identifier: https://orcid.org/0000-0003-2573-8442.

      Biography

      Elizabeth Taber, PharmD, BCPP is Clinical Pharmacy Specialist, Psychiatry, University of North Carolina Medical Center, Chapel Hill, NC.

      Biography

      Gary Linder is Durham County EMS, Tactical Medic Education Coordinator, Durham, NC.