[Assessing agitation, preventing escalation]

Agitated patients present a challenge in clinical practice. Management strategies vary depending on severity, ranging from (non-)verbal de-escalation to pharmacological sedation. This article outlines a stepwise approach to treating agitation, distinguishing between mild, moderate, and extreme agitation. Mild agitation can often be managed with verbal and non-verbal techniques, while moderate agitation may require anxiolytics or antipsychotics. Extreme agitation necessitates rapid and effective sedation, administered by trained healthcare professionals, to ensure the safety of both patients and caregivers. Midazolam is commonly used for extreme agitation; however, research suggests that droperidol may be more effective and safer. When this initial approach is ineffective, ketamine can be considered. This article provides practical guidelines for selecting the appropriate interventions to optimize both patient and caregiver safety and well-being.