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EMR
EMT
AEMT
Paramedic
Extended
Agitation / Combativeness
Agitation / Combativeness
Scene Safety
Law Enforcement should always
be requested
Universal Patient Assessment
Remove patient from stressful
environment
Only restrain the patient
if they are threatening
the safety of themselves,
the crew, or others. Do
not attempt to subdue or
restrain unless adequate
personnel are present
and law enforcement is
on the scene. Evacuate if
they are not.
Try to identify and treat the
underlying cause of the agitation.
If there is no treatable cause and the
patient remains a threat to themselves
or others, the paramedic may choose to
attempt medical sedation
Keep in mind that many accidental
needle sticks occur on medical
personnel while dealing with
violent or agitated patients.
Clinical Considerations
Agitation causes may include:
Excessive heat/cold
Hypoxia
Lack of blood flow to brain
Head injury or stroke
High or low BGL
Metabolic disorders
Neurologic disease
Haldol
5mg IM
And / Or
Versed
5mg IM
Have suction, BVM, and
intubation equipment ready, be
prepared to protect the airway,
consider extra resources.
Monitor SpO2 and ETCO2.
History of Schizophrenia or Allergy to Ketamine
Yes
No
Ketamine
1mg/kg IM
Have suction, BVM, and
intubation equipment ready, be
prepared to protect the airway,
consider extra resources.
Monitor SpO2 and ETCO2.
May
repeat Haldol
5mg IM in
10 minutes if patient is still
combative and vital signs are
adequate.