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Use of sedatives and restraints for treatment of agitation in the emergency department

Published:December 17, 2018DOI:https://doi.org/10.1016/j.ajem.2018.12.027
      Agitation is a growing and pervasive problem in emergency departments (EDs) across the United States, with an estimated 1.7 million events occurring annually in emergency settings [
      • Holloman Jr., G.H.
      • Zeller S.L.
      Overview of Project BETA: best practices in evaluation and treatment of agitation.
      ,
      • Miner J.R.
      • Klein L.R.
      • Cole J.B.
      • et al.
      The characteristics and prevalence of agitation in an urban county emergency department.
      ]. Treatment routinely involves the use of coercive measures consisting of physical restraints and sedatives, but they can lead to significant harm for patients. Cited adverse events have included lasting psychological distress, respiratory depression, physical trauma, and asphyxiation leading to cardiac arrest [
      • Mohr W.K.
      • Petti T.A.
      • Mohr B.D.
      Adverse effects associated with physical restraint.
      ,
      • Karger B.
      • Fracasso T.
      • Pfeiffer H.
      Fatalities related to medical restraint devices-asphyxia is a common finding.
      ,
      • Korczak V.
      • Kirby A.
      • Gunja N.
      Chemical agents for the sedation of agitated patients in the ED: a systematic review.
      ]. Efforts to reduce threats to patient safety have recently led to calls for utilization of evidence-based algorithms to help clinicians determine when coercive measures are most appropriate [
      • Nordstrom K.
      • Zun L.S.
      • Wilson M.P.
      • et al.
      Medical evaluation and triage of the agitated patient: consensus statement of the american association for emergency psychiatry project Beta medical evaluation workgroup.
      ].

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