Rapid Sedation

Chemical sedation alone, or in conjunction with physical restraint, may assist in the safe management of an agitated or violent patient who seems unresponsive to verbal de-escalation strategies.

Rapid tranquillizing may be useful in managing acute, disturbed and psychiatric patients who are seriously agitated.

Rapid tranquillizing is warranted for patients who are:

• Without capacity
• Agitated
• Pose a risk to themselves
• Pose a risk to others

Recommended dosage: (Using NICE guideline)

Rapid tranquilization involves a neuroleptic agent such as haloperidol either alone or in combination with a low-dose benzodiazepine such as lorazepam or midazolam.

• For most patients 2 mg lorazepam orally, is recommended

For very challenging situations in which urgent control is required. IM haloperidol (5-10 mg) and/or IM lorazepam 2 mg can be administered. This is a potent cocktail which is commonly used.

Note that appropriate patient monitoring is required. IM drugs may take up to 30 minutes to begin to have an appreciable effect. Intravenous drugs should be used only in exceptional circumstances.