Approach to management
• React calmly.
• Try to control the disturbed patient gently.
• Ensure the safety of all staff.
• An adequate number of staff to accompany the doctor is essential—six
is ideal (one for immobilisation of each limb, one for the head and one
to assist with drugs).
• Diazepam or midazolam 2.5–5 mg increments IV, repeated every
3–4 mins until required level of sedation reached (max 20–30 mg) or if
IM route best
– droperidol (Droleptan) 5–10 mg IM (probably best) or
– haloperidol 5–10 mg (o) up to 30 mg/d (watch for possible laryngeal
dystonia and treat with benztropine 2 mg IM)
• If intramuscular benzodiazepines required: midazolam (Hypnovel)
2.5–5 mg IM as single dose
• Then search for the cause and/or refer accordingly