Psychiatric emergencies

Rapid tranquillisation for the very disturbed patient

1.

2.

Try to calm the patient verbally. Adopt a calm body posture, listen to them and speak calmly to them. Most patients can be settled through good communication skills. If the patient or others are at risk, rapid tranquilisation needed:
If armed, call police Control and restrain patient: plan action as a team, ideally one person for each limb and head (i.e. 5), clear leader, move together. Use minimum force necessary, avoiding injury. Talk to the patient- he will be genuinely terrified, tell him what you are doing

Rapid tranquillisation for the very disturbed patient

3.

Medication
Intramuscular lorazepam 2mg or diazepam 5-10mg (NOT BOTH) Haloperidol im 5mg Can use both haloperidol and diazepam but give at least 30 mins before repeating sedation and DO NOT EXCEDE 30mg haloperidol or 40mg diazepamin 24 hours.

Rapid tranquillisation for the very disturbed patient

Intravenous

Only use if absolutely necessary, im normally satisfactory and safer Diazepam 5-10mg over 2 mins, NOT AS A BOLUS. Risk of respiratory depression and death. NEVER USE CHLORPROMAZINE

Rapid tranquillisation for the very disturbed patient

Use smaller doses and repeat if necessary Monitor respiratory rate, pulse, blood pressure after emergency sedation. Rehydrate 4. The goal is to reduce agitated behaviour, not somnolence or sedation. 5. Always respect right to safe and humane treatment.

Extrapyramidal crises

Acute dystonias Give im or oral benztropine 2mg

Stupor

Unawareness of surroundings Severe depression, catatonic schizophrenia, mania Dehydration: REHYDRATE If depressed, ECT is treatment of choice If schizophrenia, antipsychotics