Acutely agitated patients are commonly seen in the emergency department (ED). As these patients may cause harm to themselves or others, a large proportion need to be managed with injectable sedative medications such as benzodiazepines (eg midazlolam) and/ or antipsychotics (e.g droperidol).
Unfortunately, these medications may precipitate life threatening events (e.g hypoventilation). Safety data related to the use of these medications for the management of acute agitation in the ED setting are scant. Acute agitation in the ED setting is usually caused by mental health issues or substance abuse, again little is known about which sedative medications are best suited for different groups of acutely agitated patients.
The aim of this study is to determine the nature and incidence of adverse events associated with parenteral sedation medication administered to acutely agitated patients in the ED and to determine the risk factors for these adverse events. It is a multicentre national observational study, aiming to recruit 2000 patients over the age of 18, over a 2 year period. It is hoped that the evidence this study generates will define the risk of AE in this population and may guide clinicians in future treatment choices in sedating this challenging group of patients, hopefully reducing future AE.
The research team undertook a prospective observational study and a clinical trial of parenteral sedation for the management of acute agitation. They included 904 agitated adult patients who required parenteral sedation from 2014 to 2017 in twelve Australian EDs, They found sedation‐related AEs are common, especially respiratory events. Elderly patients, sedation with multiple sedatives within 60 minutes, and alcohol intoxication increased the risk.
-Yap C. Y.L., Taylor D. McD., Kong D.C.M., Knott J.C., Taylor S.E., The Sedation for Acute Agitation in Emergency Department Patients: Targeting Adverse Events (SIESTA) Collaborative Study Group,"Risk Factors for Sedation‐Related Events During Acute Agitation Management in The Emergency Department", 'SAEM', 02 July 2019. doi: 10.1111/acem.13826
Trainee Grant Scheme
Dr Barrie Field
Prof David Taylor
Dr Ogilvie Thom