Aggression
Summary
Management
--END OF SUMMARY--
Management
- Verbal coaxing
- Physical restraints (only until they have calmed down)
- (If immediate sedation reqd) Typical antipsych (Droperidol)/ Benzo (Midazolam)/ combined typical antipsych+benzo (eg droperidol+midazolam/ haloperidol+midazolam)
- (If source is drugs/alcohol) Midazolam
- (If source is unknown) Benzo
- (If source is psych condition) Typical antipsych/ atypical antipsych
--END OF SUMMARY--
Aetiology
Assessment
Management
Non Pharm:
Pharm:
Source
Medscape 2014
UpToDate 2014
- Presence of co-morbid substance abuse
- Dependence
- Intoxication
- Neuropsychiatric deficits
- Personality characteristics (eg. antisocial personality traits)
- Environmental factors (chaotic home or hospital situation)
Assessment
- Gathering of information about past and current behaviour
- Review of past treatment
- Clinical examination of the patient over time
- Rule out somatic conditions that require emergency treatment (eg Delirium)
- MSE (include: suicide)
- Consider: somatic condition, substance usage
Management
Non Pharm:
- Constant monitoring
- Take verbal threats seriously.
- Remain several feet away to avoid crowding the patient.
- Clear the area of other patients.
- Summon additional help (a "show of force" or a "show of concern"); this is not a time for heroics.
- Remain calm, maintain a confident and competent demeanor, and attempt to deescalate by engaging the patient in conversation.
- If restraints are necessary, have at least 4 people available.
Pharm:
- Benzo (Lorazepam) - 1st line
- If uncontrollable, 4 people pin pt prone on floor, 1 administer IMI Midazolam and olanzapine
- If even more uncontrollable, use zuclopenthixol (lasts 3 days)
- Antipsychotics (atypical - no extrapyramidal sefx), if req
Source
Medscape 2014
UpToDate 2014