Management of acute agitation and violence
Serotonin toxicity
Cardiovascular complications
Cerebrovascular complications
Management of acute agitation and violence
Key points:- Urgent sedation is a useful technique for management of acutely agitated or violent patients in an emergency setting.
Strength of evidence: 2 stars
- A range of drugs may be useful, including droperidol, haloperidol, midazolam and lorazepam.
Strength of evidence: 2 stars
- In the doses studied, droperidol produces more rapid sedation than haloperidol and lorazepam.
Strength of evidence: 2 stars
- Benzodiazepines and antipsychotics may be used in combination and may be more efficacious than the use of single agents.
Strength of evidence: 1 star
Serotonin toxicity
Key points:- Serotonin toxicity may occur after ingestion of amphetamine derivatives alone or if ingested with other serotonergic agents such as antidepressants.
Strength of evidence: 1 star
- Pharmacological agents which antagonise the effects of serotonin such as cyproheptadine and chlorpromazine may have a limited role in attenuating symptoms of toxicity.
Strength of evidence: 1 star
- Non-specific agents such as benzodiazepines may assist in reducing muscle rigidity, agitation and seizures.
Strength of evidence: 1 star
Cardiovascular complications
Key points:- Psychostimulant-related chest pain is a common presentation.
Strength of evidence: 1 star
- It is more common after cocaine than amphetamine use but can occur with both.
Strength of evidence: 1 star
- Benzodiazepines can be particularly useful.
Strength of evidence: 2 stars
- Continued psychostimulant use is associated with an increased risk of subsequent infarction.
Strength of evidence: 1 star
Cerebrovascular complications
Key points:- Use of psychostimulants is a risk factor for several cerebrovascular events.
Strength of evidence: 1 star
- Onset of symptoms occurs during or within hours of use.
Strength of evidence: 1 star
- Cerebrovascular events occur in patients with little in the way of additional risk factors.
Strength of evidence: 1 star
- Management should follow standard procedures with early consideration of angiography.
Strength of evidence: 1 star