Considerations in the use of benzodiazepines and antipsychotics in the emergency department

Agitated patients may come to the emergency department because of flares of a psychiatric illness, drug withdrawal, or reaction to a medical condition or trauma. Pharmacologic agents such as lorazepam may offer benefits to these patients, regardless of the cause of their symptoms. It is important to be familiar with the dosage, administration, and onset of effects of the commonly used agents. The emergency nurse should be aware that akathisia in a patient receiving an antipsychotic medication is not agitation and should not be treated with a higher dose of an antipsychotic drug. The nurse needs to be able to recognize other adverse effects (e.g., acute dystonic reactions), reassure the patient, and administer the treatment to relieve the adverse effect. If the patient's chart from a previous ED visit is readily available, it is a good idea to identify the drug treatment that was successful in the past. The same drug at the same dosage is likely to be effective again. For patients discharged home, it is important to ensure that these patients will be able to obtain the necessary maintenance medication and that they have a follow-up visit planned before they leave the emergency department.