View source for Template:General ED Psychiatric Management

===[[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
**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]])