Managing acute agitation

Stop laughing, you’ve probably heard someone suggest that this might be a good way to administer sedation to acutely agitated patients.

I think once you’ve had to do this more than a few times, you realise that the ongoing management doesn’t stop when the patient settles – they’re now relying on us to ensure their safety, which can feel somewhat paradoxical given that (at some level) we were probably feeling uneasy only moments earlier.

This post from Tim Leeuwenburg discusses some lessons learnt from when things go wrong and introduces some valuable points to consider;

The take-away here is that we should be thinking about managing acute agitation as a procedure that is a continuum of our care, not an end-point in our management.

If this is starting to make sense, you might be interested to know that ALiEM have an entire self-paced learning module in their ALiEMU which steps you through Procedural Sedation and Analgesia in the ED;

Some time ago, I got at least $1,000 of free advice from an outstanding pre-hospital practitioner – to paraphrase – if you can anticipate what happens next,  you won’t get an unwelcome surprise !


Ketamine for acute pain

We’ve recently updated our pain management guideline to include Ketamine in addition to IV opioids for severe pain.

Here’s a marvellous post from the Skeptics’ Guide to Emergency Medicine that should give you a better understanding of where the evidence is, and why this is an outstandingly good idea;

Be sure to scroll all the way to the end where you’ll find a couple of ‘paper in a picture’ graphics that summarise the literature !