The Art of Managing Agitated Patients

2025-05-25

Effective agitated patient management requires a fundamental shift from viewing these encounters as behavioral problems to recognizing them as medical emergencies with underlying pathophysiological processes. By systematically addressing safety, identifying root causes, selecting appropriate pharmacological interventions, and maintaining rigorous post-sedation monitoring, EMS providers can dramatically improve outcomes for these challenging patients. Remember: you cannot talk someone out of a hypoglycemic crisis, hypoxic emergency, or sympathomimetic overdose. When verbal de-escalation fails, it's not your failure as a provider—it's an indication that medical intervention is required to address the underlying pathophysiology driving the patient's agitation. The goal isn't just to control behavior—it's to provide definitive medical care that addresses the root cause of the patient's distress while maintaining safety for everyone involved.

Our guest is Patrick Hendley, a practicing paramedic and an expert in agitated patient management. We'll explore the pathophysiology behind agitation and essential strategies for EMS providers faced with these calls. We'll also examine sedation choices, restraint use, and post-sedation care through a lens of real-world EMS principles. Join us as we look at more than just de-escalation, but understanding and acting effectively and ethically to safeguard everyone involved.

Don't forget to check out our sponsor, The Resus Tailor, for custom bag designs tailored to your EMS needs. Reach out to them at theresustailor.com.

00:00 Introduction to Loud and Clear EMS

00:27 Today's Topic: Managing the Agitated Patient

01:00 Guest Introduction: Patrick Henley

02:17 Sponsor Message: The Recess Tailor

03:01 Case Study: Agitated Patient Scenario

06:04 Understanding Agitation and Safety Principles

08:12 Sympathetic Nervous System and Agitation

10:00 Factors Contributing to Agitation

13:02 Drug Influence on Agitation

19:05 Safety Hierarchy in EMS

30:34 Transport Safety and Patient Management

33:07 Treating Underlying Causes of Agitation

39:08 Managing Patient Anxiety with Fentanyl and Oxygen

39:45 Using Ketamine for Pain Control and Sedation

40:25 Addressing Mixed Presentations: Schizophrenia and Substance Use

41:38 Treating Sympathomimetic Overdose and Psychosis

42:56 The Importance of Post-Sedation Monitoring

43:51 Verbal De-escalation and Benzodiazepines

45:00 Using Time as a Tool for Postictal Patients

46:11 Understanding Benzodiazepines and GABA Receptors

47:59 Antipsychotics and Ketamine: When Benzos Aren't Enough

59:17 The Role of Physical Restraints in Patient Management

01:08:43 Effective Handoff and Continuity of Care

01:18:11 Final Thoughts and Core Principles

Resources

The Resus Tailor - https://www.theresustailor.com/
The Art of Managing Agitated Patients Supplemental Blog Post - https://emspodcast.com/the-art-of-managing-agitated-patients/

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