EM Cases · Acute agitation and sedation
Severe methamphetamine agitation — rapid tranquillisation resus station
ACEM Fellowship resus/behavioural emergency station testing safety, organic screen, de-escalation, droperidol-first pharmacology, and avoidance of prone restraint.
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Study tools
Target exams
ACEMFRCEMABEMFRCPCCCFPEMEBEEM
Prompt
A hyperthermic, violent stimulant-intoxicated patient who requires graded de-escalation then parenteral sedation with airway-ready monitoring.
Stem
All values, findings and observations in this station are fictional and invented for teaching assessment; they do not describe a real person.
Format. Clinical-management station, 11 minutes. You are the EM consultant in resus.
Candidate instructions. Ensure staff safety and manage the patient. Examiner plays security lead and nurse.
References3ShowHide
- [1]Richmond JS, Berlin JS, Fishkind AB, et al. Verbal de-escalation of the agitated patient: consensus statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup. Western Journal of Emergency Medicine, 2012.PMID 22461917
- [2]Isbister GK Droperidol or olanzapine, intramuscularly or intravenously, monotherapy or combination therapy for sedating acute behavioural disturbance. Annals of Emergency Medicine, 2017.PMID 27974168
- [3]Weedn V, Steinberg A, Speth P. Prone restraint cardiac arrest in in-custody and arrest-related deaths. Journal of Forensic Sciences, 2022.PMID 35869602