Acute Behavioural Disturbance

Authors: Andy Neill, Simon Laing / Codes: CAP27, CAP30, HMP5 / Published: 21/12/2016

Welcome back to the podcast.

Today we have an interview with Cian McDermott, an Irish trained EP working in Australia and an old friend of mine. Cian has been doing some work in his own ED in coming up with protocols and pathways for managing the agitated and aggressive patient in the ED.

This has got some #FOAMed love recently in particular with Reuben Strayer’s talk from SMACC and my own little contribution from EuSEM in Vienna

Reuben References/Slides

Andy references/slides

References:

  1. NSW Protocol
  2. NICE Guidance
  3. RCEM Guidance
  4. Ambulance Victoria CPG
  5. Sedation Assessment Tool. Calver 2011
  6. DORM 2 and DORM both showing the utility (and likely safety) of droperidol (shame we don’t have it. Other studies also supporting it
  7. Nice Blog from Brent at Canadiem.org
  8. Recent splurge of ketamine articles (perhaps in reaction to the furore over QTc in droperidol from the FDA)
    • Pseudo randomised (half year v other half year)
      • Cole JB, Moore JC, Nystrom PC, Orozco BS, Stellpflug SJ, Kornas RL, et al. A prospective study of ketamine versus haloperidol for severe prehospital agitation. Clinical Toxicology. 2016 Apr 22;:1–7.
    • Observational
      • Isbister GK, Calver LA, Downes MA, Page CB. Ketamine as Rescue Treatment for Difficult-to-Sedate Severe Acute Behavioral Disturbance in the Emergency Department. Ann Emerg Med. Elsevier; 2016 May 1;67(5):581–1.
    • Chart Reviews
      • Keseg D, Cortez E, Rund D, Caterino J. The Use of Prehospital Ketamine for Control of Agitation in a Metropolitan Firefighter-based EMS System. Prehosp Emerg Care. 2014 Jun 16;19(1):110–5.
      • Burnett AM, Peterson BK, Stellpflug SJ, Engebretsen KM, Glasrud KJ, Marks J, et al. The association between ketamine given for prehospital chemical restraint with intubation and hospital admission. Am J Emerg Med. 2015 Jan;33(1):76–9.
      • Hopper AB, Vilke GM, Castillo EM, Campillo A, Davie T, Wilson MP. Ketamine use for acute agitation in the emergency department. JEM. 2015 Jun;48(6):712–9.
      • Scheppke K, Braghiroli J, Shalaby M, Chait R. Prehospital Use of IM Ketamine for Sedation of Violent and Agitated Patients. WestJEM. 2014 Nov 1;15(7):736–41.
    • Editorial
      • Green SM, Andolfatto G. Let’s ‘Take’Em Down’ With a Ketamine Blow Dart. Vol. 67, Annals of emergency medicine.

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