Effectiveness of pharmacological treatments for severe agitation in real-world emergency settings: protocol of individual-participant-data network meta-analysis.

Background: Severe psychomotor agitation and aggression often require immediate pharmacological intervention, but clear evidence-based recommendations for choosing among the multiple options are lacking. To address this gap, we plan a systematic review and individual-participant-data network meta-analysis to investigate their comparative effectiveness in real-world emergency settings with increased precision.

Methods: We will include randomized controlled trials investigating intramuscular or intravenous pharmacological interventions, as monotherapy or in combination, in adults with severe psychomotor agitation irrespective of the underlying diagnosis and requiring rapid tranquilization in general or psychiatric emergency settings.

Factors associated with paediatric and adolescent Emergency Department presentations involving acute behavioural disturbance events.

Aim: Studies reporting factors associated with paediatric/adolescent acute behavioural disturbance (ABD) in the Emergency Department (ED) are lacking. The aim of this study is to describe paediatric/adolescent ED presentations involving ABD events.

Methods: A retrospective chart review of presentations involving ABD events, identified via hospital security log, to a tertiary referral paediatric ED during the 2017 calendar year.

QT interval prolongation in opioid agonist treatment: analysis of continuous 12-lead electrocardiogram recordings.

Aims: Methadone is a widely used opioid agonist treatment associated with QT prolongation and torsades de pointes. We investigated the QT interval in patients treated with methadone or buprenorphine using continuous 12-lead Holter recordings.

Methods: We prospectively made 24-h Holter recordings in patients prescribed methadone or buprenorphine, compared to controls.

Population pharmacokinetics of intramuscular droperidol in acutely agitated patients.

Background: Intramuscular droperidol is used increasingly for sedation of aggressive and violent patients. This study aimed to characterise the pharmacokinetics of intramuscular droperidol in these patients to determine how rapidly it is absorbed and the expected duration of measurable drug concentrations.

Methods: We undertook a population pharmacokinetic analysis of a subgroup of patients from a clinical trial comparing droperidol and midazolam: 17 receiving 5 mg and 24 receiving 10 mg droperidol.

Ketamine as Rescue Treatment for Difficult-to-Sedate Severe Acute Behavioral Disturbance in the Emergency Department.

Study Objective: We investigate the effectiveness and safety of ketamine to sedate patients with severe acute behavioral disturbance who have failed previous attempts at sedation.

Methods: This was a prospective study of patients given ketamine for sedation who had failed previous sedation attempts. Patients with severe acute behavioral disturbance requiring parenteral sedation were treated with a standardized sedation protocol including droperidol.

The Safety and Effectiveness of Droperidol for Sedation of Acute Behavioral Disturbance in the Emergency Department.

Study Objective: We investigate the safety and effectiveness of droperidol for sedation of acute behavioral disturbance in the emergency department (ED).

Methods: This was a prospective observational study in 6 EDs (August 2009 to April 2013). Adult patients requiring parenteral sedation for acute behavioral disturbance received droperidol 10 mg.

Droperidol v. haloperidol for sedation of aggressive behaviour in acute mental health: randomised controlled trial.

Background: Agitation and aggression are significant problems in acute psychiatric units. There is little consensus on which drug is most effective and safest for sedation of these patients.

Aims: To compare the effectiveness and safety of haloperidol v.

Randomized controlled trial of intravenous antivenom versus placebo for latrodectism: the second Redback Antivenom Evaluation (RAVE-II) study.

Study Objective: Latrodectism is the most important spider envenomation syndrome worldwide. There remains considerable controversy over antivenom treatment. We aimed to investigate whether antivenom resulted in resolution of pain and systemic effects in patients with latrodectism who received standardized analgesia.

Intralipid therapy does not improve level of consciousness in overdoses with sedating drugs: a case series.

Objective: To assess the effect of intralipid emulsion therapy (ILE) in sedating drugs presenting to an urban emergency department.

Methods: Following the introduction of a clinical protocol for the use of ILE a retrospective chart review was undertaken, which describes the use of ILE in treating sedating drug overdose in a facility with a tertiary referral level clinical toxicology unit. Demographic data as well as details of drug ingested, physiological parameters and disposition were extracted from the medical record.

High dose droperidol and QT prolongation: analysis of continuous 12-lead recordings.

Aims: To investigate the QT interval after high dose droperidol using continuous 12-lead Holter recordings.

Methods: This was a prospective study of patients given droperidol with a continuous Holter recording. Patients were recruited from the DORM II study which included patients with aggression presenting to the emergency department.

A prospective study of high dose sedation for rapid tranquilisation of acute behavioural disturbance in an acute mental health unit.

Background: Acute behavioural disturbance (ABD) is a common problem in psychiatry and both physical restraint and involuntary parenteral sedation are often required to control patients. Although guidelines are available, clinical practice is often guided by experience and there is little agreement on which drugs should be first-line treatment for rapid tranquilisation. This study aimed to investigate sedation for ABD in an acute mental healthcare unit, including the effectiveness and safety of high dose sedation.

Parenteral sedation of elderly patients with acute behavioral disturbance in the ED.

Purposes: This study aimed to investigate sedation of elderly patients with acute behavioral disturbance (ABD) in the emergency department (ED), specifically the safety and effectiveness of droperidol.

Basic Procedures: This was a prospective study of elderly patients (>65 years) with ABD requiring parenteral sedation and physical restraint in the ED. Patients were treated with a standardized sedation protocol that included droperidol.

Dexmedetomidine in the emergency department: assessing safety and effectiveness in difficult-to-sedate acute behavioural disturbance.

Objectives: To investigate the safety and effectiveness of dexmedetomidine for sedating patients in whom previous attempts at sedation in the emergency department have failed.

Methods: A study was carried out on dexmedetomidine for sedation of patients with acute behavioural disturbance for whom at least two previous attempts at sedation with other drugs had failed. Either a loading dose of dexmedetomidine was administered or a loading dose then an infusion.

Sedation assessment tool to score acute behavioural disturbance in the emergency department.

Objective: The objective of the study was to evaluate the effectiveness of the sedation assessment tool (SAT) in assessing patient response to treatment for acute behavioural disturbance (ABD).

Methods: The SAT is a simplified version of the altered mental status score (AMSS) and is a 7-point scale assessing levels of agitation and sedation using only two descriptors. To assess the SAT we firstly compared plots of the SAT and the AMSS versus time in patients with ABD recruited to a clinical trial.

Individual patient assessment of methadone-induced QT prolongation with digital holter recording.

A 27-year-old male who had been on methadone therapy for 6 months was investigated with a 12-lead digital holter because of a prolonged QT on a standard 12-lead electrocardiogram (ECG). The patient had 24-hour holter recording on and off methadone therapy and multiple digitized 12-lead ECG data were captured for on-screen measurement of the QT interval. For each 24-hour period QT-HR pairs were plotted on the QT nomogram showing QT prolongation on methadone but not when it was ceased.

Digital Holter measurement of QT prolongation in ziprasidone overdose.

Objective: QT prolongation is an important complication in drug overdose, particularly with some antidepressants and antipsychotics. There are problems with the accurate measurement of the QT interval and determining for what QT interval patients should be monitored, because of the risk of torsades des pointes (TdP). We report a case of ziprasidone overdose with QT prolongation, demonstrating different methods of measuring the QT interval.

Randomized controlled trial of intramuscular droperidol versus midazolam for violence and acute behavioral disturbance: the DORM study.

Study Objective: We determine whether droperidol, midazolam, or the combination is more effective for intramuscular sedation in violent and acute behavioral disturbance in the emergency department (ED).

Methods: We conducted a blinded randomized controlled trial of intramuscular sedation for violent and acute behavioral disturbance, comparing droperidol (10 mg), midazolam (10 mg), and droperidol (5 mg)/midazolam (5 mg). Inclusion criteria were patients requiring physical restraint and parenteral sedation.

Risperidone overdose causes extrapyramidal effects but not cardiac toxicity.

Objective: The aim of this study was to describe the clinical and electrocardiographic features of risperidone overdose, including the frequency of dystonic reactions.

Methods: A consecutive series of admissions for risperidone overdose (>6 mg) were identified from a prospective database of poisoning admissions to a regional toxicology service. Data extracted included patient demographics, details of ingestion, clinical features including neurological findings and evidence of dystonias, electrocardiographic parameters (heart rate [HR], QRS, and QT intervals), complications, and medical outcomes including intensive care unit admission.

The impact of a standardised intramuscular sedation protocol for acute behavioural disturbance in the emergency department.

Background: Acute behavioural disturbance (ABD) is an increasing problem in emergency departments. This study aimed to determine the impact of a structured intramuscular (IM) sedation protocol on the duration of ABD in the emergency department.

Methods: A historical control study was undertaken comparing 58 patients who required physical restraint and parenteral sedation with the structured IM sedation protocol, to 73 historical controls treated predominantly by intravenous sedation, according to individual clinician preference.

The dark side of the moon.

Objective: The belief that the full moon and disturbed behaviour are closely linked is alive and well, despite studies to the contrary. We investigated the possibility that there is an association between only extreme behavioural disturbance and the full moon.

Design, Setting And Participants: We undertook an observational study of patients with violent and acute behavioural disturbance who presented to the emergency department of Calvary Mater Newcastle and patients with less severe behaviour for whom hospital security calls were made.

Inter-rater reliability of manual QT measurement and prediction of abnormal QT,HR pairs.

Objectives: To assess interobserver agreement when trained healthcare staff measure the QT interval using a standardized approach across a range of QT lengths.

Methods: A sample of 110 electrocardiograms (ECGs) was taken from general and psychotropic overdose admissions to the emergency department including drugs known to cause QT prolongation and Torsades de Pointes. Four of the authors measured the QT interval in all ECGs using a previously developed approach.