Rapid tranquilization of the violent patient

Agitated, psychotic patients with the potential for violence pose significant management problems for emergency department staff. With the advent of rapid tranquilization (RT), clinicians were offered a safe, effective method for controlling such patients, eliminating the need for restraints or seclusion rooms. While RT is regarded as a major treatment innovation in psychiatry, nonpsychiatrists are reluctant or unaware of the uses of antipsychotic medication as it pertains to RT. This article provides a brief overview of the pharmacokinetics of antipsychotic medication and reviews the following aspects of RT: route of administration, dosing, time intervals between doses, side effects, and alternative medications for RT. The authors also offer practical guidelines for RT use in the emergency department.