Acute agitation and rapid tranquillisation

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Target exams

Red flags

• Fever, fluctuating attention, hypoxia, or hypoglycaemia with agitation — medical emergency first, not primary psychiatric RT
• IM olanzapine plus parenteral benzodiazepine — never co-administer; profound respiratory depression risk
• Extreme continuous agitation with hyperthermia or collapse risk — severe behavioural disturbance needing medical resuscitation capacity
• Prolonged prone restraint — positional asphyxia and sudden death risk
• Post-RT unrousable patient or falling SpO2 — treat as airway emergency, not 'settled'
• Akathisia misread as agitation leading to more antipsychotic — stop and treat the side effect
• QTc prolongation or high cardiac risk before high-dose butyrophenones without ECG review