Management of Aggressive Patients
See overleaf for general principles and precautions.
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See further information regarding management of these conditions.
1. Consider cause: Alcohol withdrawal Drug abuse / withdrawal
Advanced malignancy Hypo- / hyperglycaemia
See “General principles of management”
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Yes
2. Talk down where possible.
Access Try to obtain unobstructed access to the patient. Clear away moveable furniture and potential weapons and ask onlookers to leave quietly. Maintain a clear exit route.
Time Do not rush, allow time for the patient to calm down. Most patients can be “talked down” in time. Engaging patients in conversation and allowing them to air their grievances may be all that is required. Avoid distraction (e.g. pagers), make it clear to the patient you have plenty of time (even if you don’t).
Manner / Posture Remain calm and reassuring. Listen. Allow the patient to talk, and avoid interruption. Maintain relaxed posture, with the hands visible and body sideways to the patient. Speak quietly and clearly. Explain any actions you intend to take. Be clear, direct, non-threatening and honest, as this will help confused and aroused patients to calm themselves. Address the patient by name, maintain eye contact.
Support Trying to cope alone can lead to disaster. Adequate numbers of staff, preferably trained in dealing with such situations, should be available to restrain the patient and contain the incident. This may mean summoning help before attempting to deal with a situation. Avoid crowding the patient. Ensure resuscitation facilities are available.
Patient responsive
Patient not responsive.
Allow patient to calm down in a quiet room, with regular observation.
Consider regular oral medication.
3. Offer oral medication
Lorazepam 1 to 2 mg repeated 4 hourly to max 8mg / 24 hours
& if severely aggressive: Droperidol 5 '' 20mg 4 to 8 hourly to max 120mg...