Acute Behavioural Disturbance

Also known as excited or agitated delirium.

Rapid onset of intensive agitation and physical actions that:

Epidemiology and Risk Factors

Pathophysiology

Aetiology

Clinical Manifestations

Diagnostic Approach and DDx

Investigations

Management

Safely manage and modify disturbed behaviour:

  • Safety of the patient
  • Safety of staff
  • Relevant drugs often have:
    • Narrow therapeutic index
    • Variable onset
    • Variable depth
  • Provision of safe sedation is essential

Resuscitation:

A safe a suitable sedating location with fundamental physiological monitoring is essential, with a minimum of 3 trained staff:

  • Doctor capable of ALS and airway management
  • RN capable of BLS and assisting with sedation
  • One other
  • A
    • Management of obstruction and respiratory depression

Specific therapy:

  • Pharmacological
  • Procedural
  • Physical

Supportive care:

  • For prolonged sedation
  • D
    • Extrapyramidal side effects
  • E
    • Pressure care
  • F
    • Urinary retention
      May require IDC.
  • H
    • Thromboprophylaxis

Disposition:

Preventative:

Anaesthetic Considerations

Marginal and Ineffective Therapies

Complications

Prognosis

Key Studies

References

  1. ANZCA. PS63: Guidelines for Safe Care for Patients Sedated in Health Care Facilities for Acute Behavioural Disturbance.