All Emergencies - Basic life support principles:

  1. Maintain an airway
  2. Assess breathing
  3. Monitor circulation
Monitor and record all vital signs.
Agitation During Sedation
  1. It is important to recognize that hypoxemia can cause patient agitation. Arterial oxygen saturation must be determined before any other action is taken.
  2. Sedative agents can sedate a patient's inhibitions and unmask paranoid ideation which can manifest as agitation. Further sedation of the agitated patient may make the patient more cooperative, but it can also have the opposite effect.
  3. Use caution to avoid misinterpreting agitation caused by oversedation and lack of adequate sedation, which can be caused by decreased sedative effect, hypoglycemia or even a patient that needs to go to the bathroom.
  4. Additional sedative agents must be administered exceedingly carefully since oversedation and respiratory depression are as likely as producing a quiet, cooperative patient.
  5. Verbal reassurance may help calm the patient.
  6. A benzodiazepine like midazolam often has a calming effect.
  7. A narcotic like fentanyl may be appropriate if the patient is in pain. Additional local anesthetic may also be helpful.
  8. The respiratory depressive effects of these medications are additive and ventilation must be carefully observed.
  9. General anesthesia may be the safest option for uncooperative, agitated patients.