Pharmacological management of an agitated patient in the emergency department
DOI:
https://doi.org/10.60103/phc.v28.e920Keywords:
Emergency department; agitation; sedation; safetyAbstract
Introduction: The management of patients presenting to emergency departments with agitation often involves the use of a wide variety of medications. This study aims to describe the pharmacological interventions used in an emergency department for patients requiring activation of the out-of-hospital agitation code.
Methods: A retrospective observational study was conducted, including patients treated in an emergency department under the agitation code protocol during 2024. The medications used, patient length of stay, and factors associated with pharmacological restraint were analyzed. Changes in medication patterns compared to previous years were also assessed.
Results: 216 patients were included (mean age: 40.4 (SD:12.9) years; 60.8% male), of whom 133 (61.5%) received pharmacological treatment. The most frequently used first-line drugs were intramuscular olanzapine (n=48; 22.2%), oral olanzapine (n=26; 12.0%), and intramuscular midazolam (n=21; 9.7%). 49 patients (22.6%) received at least two drugs. Compared to previous years, a decrease in the use of propofol was observed (2024: 13.9%; 2023: 14.9%; 2022: 12.8%). Alcohol intoxication was associated with increased use of intramuscular olanzapine.
Median emergency department stay was 8:54 hours (IQR: 3:45–16:35). In the univariate analysis, the use of multiple drugs and the absence of alcohol intoxication were associated with a longer stay in the emergency department, although in the multivariate model only the absence of alcohol intoxication remained as a factor associated with a longer stay.
Conclusions: Pharmacological restraint is a common practice in patients treated under the out-of-hospital agitation code. Treatment protocol standardization should be a priority to ensure consistency, improve clinical outcomes, and minimize adverse effects.
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Copyright (c) 2026 Jesus Ruiz Ramos, Marta Castella Rovira, Mª Del Mar Carceller Sindreu, Paola Ponte Marquez, Saida Zavala Carrillo, Ismael Parrilla Rios, Elisabet Rodriguez-Egea, Fernando Santos-Blas, Marcel Padrosa Planella, Olga Martínez-Piera, Mireia Puig Campmany
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