Agitation can be categorized into mild, moderate, and severe. Excited delirium is a life threatening medical emergency in which the patient presents with severe agitation, diaphoresis, tachypnea, hyperthermia, and unusual “super-human” strength (impervious to pain and fatigue).
Prompt implementation of de-escalation tactics can effectively decrease aggressive behavior. Successful de-escalation requires an empathetic attitude, patience, and a genuine interest in helping the agitated patient, regardless of their history or clinical presentation.
Chemical restraint, rather than physical restraints, is the preferred approach for managing excited delirium. Medications commonly used for agitation control include midazolam, lorazepam, haloperidol, droperidol, and atypical antipsychotics such as Ziprasidone. IM Ketamine is the drug of choice for immediate control of patients with excited agitation.
Avoid covering the agitated patient’s mouth and nose with a gloved hand. This can lead to asphyxia. To prevent the patient spitting on staff, instead, use an oxygen mask. This may also serve to improve the patient's oxygenation.