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Acute situational disturbance — Clinical Guidelines

Overview

Acute situational disturbances refer to sudden episodes of severe agitation or behavioral disruption requiring immediate intervention, often seen in emergency settings such as psychiatric emergencies or acute behavioral disturbances in emergency departments. 2 5 6

Diagnosis

Clinical assessment focusing on agitation levels, verbal and physical aggression.

No specific diagnostic tests; relies heavily on clinical judgment and patient history. 2 5

Management

First-line treatments:

- Droperidol for initial sedation 2. - Ketamine as rescue sedation for persistent agitation 2.

Adjunctive treatments:

- Dexmedetomidine for difficult-to-sedate patients 6. - Structured intramuscular (IM) sedation protocols to standardize care 8.

Assessment tools:

- Sedation Assessment Tool (SAT) for monitoring response to treatment 7.

Special Populations

Pediatrics: Not specifically addressed in provided abstracts.

Elderly: Not specifically addressed in provided abstracts.

Comorbidities: Management strategies should consider underlying psychiatric conditions; specific dosing adjustments may be necessary based on clinical judgment 2 6 8.

Key Recommendations

Use droperidol as initial pharmacological intervention for acute behavioral disturbance 2 (Evidence: Moderate).

Employ ketamine as a rescue sedative for patients who remain agitated despite initial treatment 2 (Evidence: Moderate).

Implement structured sedation protocols, particularly intramuscular routes, to standardize and potentially reduce duration of behavioral disturbance 8 (Evidence: Moderate).

Utilize assessment tools like the Sedation Assessment Tool (SAT) to monitor patient response effectively 7 (Evidence: Moderate).

Consider dexmedetomidine for patients who are difficult to sedate with conventional agents 6 (Evidence: Weak).

1 2 5 6 7 8

References

1 Chen N, Zhao M, Gao K, Zhao J. Experimental Study on the Evaluation and Influencing Factors on Individual's Emergency Escape Capability in Subway Fire. International journal of environmental research and public health 2021. link 2 Isoardi KZ, Parker LE, Page CB, Humphreys MA, Harris K, Rashford S et al.. Ketamine as a rescue treatment for severe acute behavioural disturbance: A prospective prehospital study. Emergency medicine Australasia : EMA 2021. link 3 Nevola VR, Lowe MD, Marston CA. Review of methods to identify the critical job-tasks undertaken by the emergency services. Work (Reading, Mass.) 2019. link 4 Abar B, DeRienzo V, Glick J, Wood N, Shah MN, Schneider S et al.. Implementation of an Emergency Medicine Research Associates Program: Sharing 20 Years of Experience. The western journal of emergency medicine 2018. link 5 Nash M, McDonagh C, Culhane A, Noone I, Higgins A. Rapid tranquilization: An audit of Irish mental health nursing practice. International journal of mental health nursing 2018. link 6 Calver L, Isbister GK. Dexmedetomidine in the emergency department: assessing safety and effectiveness in difficult-to-sedate acute behavioural disturbance. Emergency medicine journal : EMJ 2012. link 7 Calver LA, Stokes B, Isbister GK. Sedation assessment tool to score acute behavioural disturbance in the emergency department. Emergency medicine Australasia : EMA 2011. link 8 Calver LA, Downes MA, Page CB, Bryant JL, Isbister GK. The impact of a standardised intramuscular sedation protocol for acute behavioural disturbance in the emergency department. BMC emergency medicine 2010. link 9 Rodgers J, Foushee R, Terndrup TE, Gaddis GM. Research methods of inquiry. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2006. link 10 Gert HJ. How are emergencies different from other medical situations?. The Mount Sinai journal of medicine, New York 2005. link 11 Rahko T. Optokinetic nystagmus. Acta ophthalmologica. Supplementum 1984. link

Acute situational disturbance