TAMING THE SRU
Taming The SRU - April 13, 2021 - By Kevin Courtney
“Acute agitation is a common presentation in the Emergency Department, with some studies citing that this accounts for 2.6% of total patient encounters. The American Association for Emergency Psychiatry BETA project defines agitation as “an extreme form of arousal that is associated with increased verbal and motor activity.” Patients who are acutely agitated can pose risk to themselves as well as staff. The treatment of agitation in the ED can protect patients and staff from harm as well as allow a medical workup to proceed in order to identify any underlying medical cause. Agitation needs to be recognized quickly by ED personnel and managed while taking into account likely predisposing factors for each patient as well as co-morbidities. Though psychiatric illness can be associated with presentation of acute agitation, experts reinforce that new onset agitation in a patient without clear history of psychiatric disease should be presumed to be from a medical etiology until shown otherwise. All agitated patients should immediately have a POC glucose performed, and all women of child-bearing age should have a pregnancy test...
SUMMARY
The acutely agitated patient is common in the Emergency Department, however the underlying physiology and possible intoxicants rarely are uniform. This creates a plethora of possible agitation presentations, each requiring a sedation plan unique to the individual. While this post hopes to add specificity and evidence to your choice, remember that each patient needs a chance at environmental calming, redirection, and if sedation is needed, adequate monitoring and frequent reassessment so we can indeed do no harm.”