History

Presentation context

Context and setting

Escalation timeline

Timeline pattern

Precipitating factors

Triggers

Psychiatric symptom features

Behavioral and thought features

Substance and toxin exposure

Recent exposures

Prior episodes and baseline

Baseline and prior history

Alarm Features

Immediate danger

Imminent harm indicators

Physiologic instability

High risk physiology

High risk medical etiologies

Organic cause flags

Sedation and restraint red flags

High risk restraint scenarios

Medications

Current regimen and adherence

Home medications

Recent changes

Medication change window

High risk interaction classes

Interaction risks

Allergies and adverse reactions

Prior reactions

Contraindications to common ED agents

Medication hazard flags

Diet

Recent intake and hydration

Intake pattern

Caffeine and stimulants

Stimulant dietary exposures

Alcohol intake

Alcohol pattern

Review of Systems

Infection and inflammation

Infectious symptoms

Neurologic

Neurologic symptoms

Cardiopulmonary

Cardiopulmonary symptoms

Endocrine and metabolic

Metabolic symptoms

Toxidrome compatible symptoms

Exposure syndrome clues

Collateral History and Family History

Collateral sources

Source and reliability

Baseline function

Baseline comparison

Family history

Relevant family history

Risk Factors

Violence and escalation risk

Escalation risks

Delirium risk

Delirium risks

Withdrawal risk

Withdrawal risks

Sedation complication risk

Sedation hazards

Differential Diagnosis

Life threatening

Cannot miss etiologies

Common

Common etiologies

Less common

Less common etiologies

Mimics and distinguishing clues

Key differentiators

Past Medical History

Psychiatric history

Psychiatric diagnoses

Neurologic history

Neurologic conditions

Medical comorbidities

Medical conditions affecting sedation and restraint

Prior procedures and devices

Devices and procedures

Physical Exam

General and safety

Immediate observations

Vital signs pattern

Vital sign interpretation

Mental status and agitation severity

Behavioral assessment

Neurologic and toxidrome

Focused neurologic and toxidrome exam

Trauma survey

Trauma and occult injury screen

Post restraint safety checks

Restraint related exam

Lab Studies

Core labs

Initial labs for undifferentiated agitation

Rhabdomyolysis and hyperthermia

Exertional complication labs

Toxicology and ingestion

Exposure evaluation

Infection and sepsis

Infection evaluation

Endocrine and pregnancy

Targeted tests

Interpretation pitfalls

Common limitations

Imaging

Scoring Systems

Imaging decision supports

MRI

MRI indications in agitation workup

CT

CT indications in agitation workup

Ultrasound

POCUS uses in unstable agitation

Special Tests

Bedside cognitive screening

Delirium screening tools

Withdrawal assessment

Withdrawal scales

Agitation severity tracking

Standardized agitation scales

Capacity and consent screening

Capacity elements

ECG

Indications

When ECG changes management

High risk findings

ECG red flags

Toxidrome patterns

Overdose associated patterns

Serial ECG logic

Repeat strategy

Assessment

Etiology classification

Working category

Severity stratification

Agitation severity

Risk stratification

Harm risk synthesis

Complications to rule out

High consequence complications

Plan

First 5 minutes

Immediate stabilization

Environment and de escalation

Non pharmacologic measures

Pharmacologic approach

Medication strategy by phenotype

Medication safety and contraindications

Avoidance rules

Physical restraint considerations

Least restrictive safe option

Monitoring after sedation or restraint

Monitoring bundle

Diagnostic sequencing

Medical workup logic

Reassessment loop

Timed re evaluation

Consultation plan

Consult triggers

Disposition

ICU level care criteria

ICU indications

Inpatient admission criteria

Medical admission

Observation criteria

ED observation pathway

Psychiatric disposition criteria

Psychiatric admission or crisis pathway

Discharge criteria

Safe discharge requirements

Discharge Instructions

Copy discharge instructions

Discharge message

References

Guidelines and consensus

Core references

Source file

Project instructions source