History

Context and course

Agitation context

Symptoms and associated features

Associated features

Exposures and substances

Substance exposure history

Psychiatric and behavioral history

Psychiatric history

Medical contributors

Medical contributor history

Special populations

Special population history

Alarm Features

Immediate danger and escalation triggers

Immediate escalation triggers

Physiologic red flags

High risk etiologies

Restraint and sedation hazards

Sedation hazard flags

Medications

Current and recent medications

Medication reconciliation priorities

High risk medication classes

Interaction and contraindication checks

Medication safety checks

Diet

Recent intake and dehydration risk

Intake pattern

Stimulants and related exposures

Dietary stimulant exposures

Review of Systems

Infectious and inflammatory

Infectious symptoms

Cardiopulmonary

Cardiopulmonary symptoms

Neurologic

Neurologic symptoms

Toxicologic and withdrawal

Toxicologic symptoms

Psychiatric

Psychiatric symptoms

Collateral History and Family History

Collateral source and baseline

Collateral and baseline

Safety and access

Safety collateral

Family history

Risk Factors

Medical and neurologic risk

Medical risk factors

Substance and withdrawal risk

Substance related risk

Environmental and social risk

Contextual risk factors

Differential Diagnosis

Life threatening

Life threatening causes

Common

Common causes

Less common

Less common causes

Key distinguishing clues

Distinguishing features

Past Medical History

Relevant conditions and prior events

Relevant past history

Procedures and devices

Baseline function

Physical Exam

Initial safety focused assessment

Initial safety assessment

Vital signs and physiologic stress

Vital sign interpretation

General and trauma screen

General and trauma findings

Neurologic and mental status

Neuro and mental status

Toxidrome and rigidity examination

Toxidrome focused findings

Lab Studies

Immediate bedside tests

Core laboratory evaluation

Core labs based on presentation

Rhabdomyolysis and hyperthermia evaluation

Rhabdomyolysis evaluation

Acid base and perfusion assessment

Acid base and perfusion tests

Pregnancy related testing

Pregnancy related tests

Imaging

Scoring Systems

Agitation severity scoring

MRI

MRI indications

CT

CT indications

Ultrasound

Ultrasound use cases

Special Tests

Delirium and withdrawal tools

Bedside tools

Toxicologic adjuncts

Toxicology adjuncts

ECG

Indications and key findings

ECG use in agitation

Monitoring and repeat ECG logic

Serial ECG strategy

Assessment

Working diagnosis categories

Primary assessment framework

Severity and risk stratification

Risk stratification

Capacity and legal considerations

Plan

Immediate stabilization and safety

First minutes priorities

Nonpharmacologic de escalation

De escalation approach

Pharmacologic sedation options

Medication selection by phenotype

Medication safety and adverse effect mitigation

Medication safety

Physical restraints

Restraint use principles

Etiology directed management

Cause specific treatment

Reassessment loop

Reassessment schedule

Disposition

ICU and higher level of care criteria

ICU level criteria

Inpatient medical admission criteria

Medical admission criteria

Psychiatric admission criteria

Discharge criteria

Discharge Instructions

Copy discharge instructions

Today you were treated for severe agitation that created a safety risk

Medications and substances

Safety plan

Follow up

Return to the emergency department now if any of these happen

References

Guidelines and consensus

Core references