Emergency Management of the Agitated Patient

By: Kelvy Levit, PGY3
​Reviewed by: David Slattery, MD

Violence is rising at a concerning rate in emergency departments. According to a national survey by American College of Emergency Physicians’ (ACEP), almost 50% of emergency physicians and nearly 70% of emergency nurses report being physically assaulted at work. A troubling 97% of assailants were patients (1).
 
With these staggering statistics in mind, it’s important to not only have preventative measures in place, but also a management plan when dealing with agitated, combative, and altered patients.
 
Dealing with the agitated patient can be distressing to not only the emergency physician but also to the staff involved directly or indirectly. As providers, we are prone to cognitive errors during times of high stress. This blog will discuss the approach to the agitated patient to include verbal de-escalation techniques, options for chemical sedation, and an overview of the current literature supporting practice recommendations.

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