›Immediate workflow
›Safety
›Staff safety and security presence
›De escalation attempt if safe
›Monitoring
›Cardiac monitor
›SpO2 monitoring
›Temperature trend
›Access
›IV access if cooperative
›IM plan if unsafe for IV
›Rapid reversible checks
›Bedside glucose
›SpO2 and ventilation status
›Acute agitation management
›Medication choice by suspected cause
›Sympathomimetic intoxication
›Benzodiazepine first line
›Avoid beta blocker monotherapy
›Primary psychosis or mania
›Antipsychotic or benzodiazepine
›Avoid oversedation
›Alcohol withdrawal
›Benzodiazepine first line
›Thiamine 100 mg IV or IM before glucose if malnourished
›Dosing examples
›Lorazepam 1 mg to 2 mg PO or IV or IM
›Haloperidol 2.5 mg to 5 mg IM or IV
›Olanzapine 5 mg to 10 mg IM
›Do not do items
›Olanzapine IM plus benzodiazepine IM within 1 hour
›Physical restraint without sedation plan and monitoring
›Diagnostic plan
›Focused medical screen
›Glucose
›CMP
›CBC
›Targeted additions by features
›Fever
›Blood cultures
›LP pathway
›Rigidity or hyperthermia
›CK
›Consider NMS or serotonin syndrome
›Reassessment
›Timing
›Every 15 minutes until calm and stable
›After each medication dose
›Elements
›Airway and RR
›Vital sign trend
›Agitation scale trend
›Escalation triggers
›Persistent severe agitation after 2 medication rounds
›Rising temperature or CK