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Immediate safety and stabilization
Safety priorities
Personal safety and scene control
Staff safety positioning and exit access
Remove potential weapons and hazards
Patient safety
Continuous visual observation for severe agitation
Fall risk and aspiration risk mitigation
Early team activation
Security support for unsafe behavior
Senior clinician presence for high-risk sedation
Rapid physiologic threats
Time-critical threats
Airway and ventilation risk
Hypoventilation after sedatives
Aspiration risk with vomiting or reduced consciousness
Circulation and perfusion risk
Shock states including hemorrhage and sepsis
Hypertensive emergency with end-organ signs
Temperature and metabolic risk
Hyperthermia with stimulant toxidrome
Hypoglycemia as reversible cause
Neurologic catastrophe risk
Intracranial hemorrhage after head trauma
Status epilepticus and postictal agitation
Rapid reversible causes
Immediate bedside checks
Point-of-care glucose
If glucose low, immediate dextrose per protocol
If recurrent low glucose, consider long-acting hypoglycemic exposure
Pulse oximetry and end-tidal CO2 when sedated
If hypoventilation, airway repositioning and assisted ventilation
If apnea, immediate airway management escalation
Temperature
If hyperthermia, active cooling and sedation escalation pathway
If hypothermia, warming and metabolic evaluation
Nonpharmacologic de-escalation
Environmental control
Low stimulation setting
Quiet room and reduced crowding
Limit personnel to essential staff
Basic needs
Pain control pathway when pain suspected
Hunger thirst toileting addressed when safe
Verbal de-escalation
Communication stance
Calm tone and simple choices
Clear limits and safety expectations
Behavioral techniques
Validate distress without agreeing to unsafe demands
Offer oral medication as first option when feasible
Medical vs primary psychiatric pathway
Initial decision points
High suspicion medical delirium
Acute onset and fluctuating course
Inattention or disorganized thinking
High suspicion intoxication or withdrawal
Autonomic hyperactivity
Mydriasis diaphoresis tremor
High suspicion primary psychiatric
Known psychiatric history with stable vitals
Organized delusions without delirium features
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.