# Management of the Aggressive/Violent Patient

## Overview

This module describes the procedure of managing an aggressive or violent patient using physical or pharmacological containment. This approach pertains to the

aggressive

aggressive

Aggressive patients may display

1. Potential violence (thoughts of suicide or homicide without action). Goal is prevention.
2. Imminent violence (restless, irritable, abusive, hostile, threatening imminent action). Goal is de-escalation.
3. Emergent violence (physically forceful, assaultive, destructive patient endangering others). Goal is containment and safety.

rather than the

agitated

agitated

Usually displaying non-specific psychological and motor hyperactivity impairing function and caregiving. Might become a risk to the safety of others.

or

angry

angry

Normal emotions may become pathological when the patient cannot control extreme emotions due to psychiatric or medical illness or substance intoxication.

patient.

## Indications

Patients displaying potential, imminent or emergent violence caused by:

## Contraindications

## Patient information and consent

Stay calm and speak to the patient in a low voice. Never insult the patient or make promises or commitments you cannot keep. Avoid direct body contact and prolonged eye contact. While it may seem counterintuitive in the heat of the moment, try to engage the patient and caregivers, reassuring them that you want to help.

### How do I explain this procedure?

“I want to help you and make you more comfortable. I want to protect you from hurting yourself or others. If you can cooperate with me, we may not need the help of the nursing staff or the security.”

### What can my patient expect?

“To help you, I need to ask you some questions about your health, your medications, or other problems. Some of these questions might annoy or upset you, but are necessary for me to help you. After that I will examine you to check for any injuries or illness that might cause you to feel this way. I might have to give you an injection to help with your frustration. You will experience a small prick, after which you will feel very relaxed and sleepy.”

### What is my patient’s role?

“Try to relax and work with me. Tell me if you need a break from the questions or examinations.”

## Preparation

### Documentation

### Equipment if sedation is indicated

## Site & Positioning

## Procedure

## Troubleshooting

The restraints are causing bruising or abrasions.

Assess the need for physical restraints, which should be unnecessary if the patient is sufficiently sedated. Restlessness and agitation can be caused by physical discomfort. Check for thirst, loosen tight clothing, ensure they are warm or cool enough, make a bedpan or urinal available. If the patient is at risk of falling off the bed or trolley, rather place a mattress on the floor. If physical restraints are absolutely required, place a sponge between the patient’s skin and the restraint.

The sedation is not working or is wearing off.

The combination of lorazepam and haloperidol can be repeated up to twice at 30-60 minute intervals as required. If a second dose does not work, consult a senior.

## Risks

## References