Template:General ED Psychiatric Management: Difference between revisions
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===[[General ED Psychiatric Management]]=== | ===[[General psychiatric approach|General ED Psychiatric Management]]=== | ||
*'''Non-pharmacologic''' | *'''Non-pharmacologic''' | ||
**Verbal de-escalation | **Verbal de-escalation | ||
**Offer comforting items: blanket, meal, pillow, etc | **Offer comforting items: blanket, meal, pillow, etc | ||
**Quiet room | **Quiet room | ||
**Physical restraints | **Physical restraints (should administer medications if restraints used, as decreases restraint time) | ||
*'''Pharmacologic''': Goal is to calm patient without oversedation | *'''Pharmacologic''': Goal is to calm patient without oversedation | ||
**No history of psychosis | **No history of psychosis | ||
***[[Haloperidol]] 0.5mg-5mg +/- lorazepam 0.25-2mg (PO/IM/IV) | ***[[Haloperidol]] 0.5mg-5mg +/- lorazepam 0.25-2mg (PO/IM/IV) | ||
****Consider adding [[benztropine]] 0.5-2mg '''or''' [[diphenhydramine]] 25-50mg (PO/IV/IM) (reduces dystonia or [[extrapyramidal reaction]]) | ****Consider adding [[benztropine]] 0.5-2mg '''or''' [[diphenhydramine]] 25-50mg (PO/IV/IM) (reduces dystonia or [[extrapyramidal reaction]]) | ||
***Consider [[risperidone]] 0.5-2mg PO '''or''' olanzapine 2.5-20mg (PO/IM/SL) '''or''' ziprasidone 10-20mg IM | ***Consider [[risperidone]] 0.5-2mg PO '''or''' [[olanzapine]] 2.5-20mg (PO/IM/SL) '''or''' [[ziprasidone]] 10-20mg IM | ||
**Known or suspected underlying psychotic illness | **Known or suspected underlying psychotic illness | ||
***Continue treatment with previous antipsychotic '''or''' | ***Continue treatment with previous antipsychotic '''or''' | ||
***PO: olanzapine 5-10mg '''or''' risperidone 0.5-2mg +/- lorazepam: 0.5-2mg | ***PO: [[olanzapine]] 5-10mg '''or''' [[risperidone]] 0.5-2mg +/- [[lorazepam]]: 0.5-2mg | ||
***IM: olanzapine 2.5-20mg '''or''' ziprasidone 10-20mg '''or''' | ***IM: [[olanzapine]] 2.5-20mg '''or''' [[ziprasidone]] 10-20mg '''or''' | ||
***(PO/IM/IV) [[Haloperidol]] 0.5-5mg +/- lorazepam 0.5-2mg | ***(PO/IM/IV) [[Haloperidol]] 0.5-5mg +/- [[lorazepam]] 0.5-2mg | ||
****Consider adding [[benztropine]] 0.5-2mg '''or''' [[diphenhydramine]] 25-50mg (PO/IV/IM) (reduces dystonia or [[extrapyramidal reaction]]) | ****Consider adding [[benztropine]] 0.5-2mg '''or''' [[diphenhydramine]] 25-50mg (PO/IV/IM) (reduces dystonia or [[extrapyramidal reaction]]) | ||
Latest revision as of 19:26, 13 November 2016
General ED Psychiatric Management
- Non-pharmacologic
- Verbal de-escalation
- Offer comforting items: blanket, meal, pillow, etc
- Quiet room
- Physical restraints (should administer medications if restraints used, as decreases restraint time)
- Pharmacologic: Goal is to calm patient without oversedation
- No history of psychosis
- Haloperidol 0.5mg-5mg +/- lorazepam 0.25-2mg (PO/IM/IV)
- Consider adding benztropine 0.5-2mg or diphenhydramine 25-50mg (PO/IV/IM) (reduces dystonia or extrapyramidal reaction)
- Consider risperidone 0.5-2mg PO or olanzapine 2.5-20mg (PO/IM/SL) or ziprasidone 10-20mg IM
- Haloperidol 0.5mg-5mg +/- lorazepam 0.25-2mg (PO/IM/IV)
- Known or suspected underlying psychotic illness
- Continue treatment with previous antipsychotic or
- PO: olanzapine 5-10mg or risperidone 0.5-2mg +/- lorazepam: 0.5-2mg
- IM: olanzapine 2.5-20mg or ziprasidone 10-20mg or
- (PO/IM/IV) Haloperidol 0.5-5mg +/- lorazepam 0.5-2mg
- Consider adding benztropine 0.5-2mg or diphenhydramine 25-50mg (PO/IV/IM) (reduces dystonia or extrapyramidal reaction)
- No history of psychosis