Discharge criteria
Requires medical workup for source?
Need for chemical sedation?
Behavior posing acute risk to self or others?
Contact security, social work, place in a safe environment and attempt non-medical behavioral de-escalation techniques
Need for physical restraints?
Clinical suspicion based on H&P
Relief of acute agitation?
Relief of acute agitation?
Pediatric psychiatry consult
Pediatric psychiatry consult
Continued signs of psychosis?
Discharge
Benzodiazepines in addition to olanzapine should be used with extreme caution as they can cause severe CNS/respiratory sedation.
Haloperidol PO or injection + Diphrenhydramine
Complete appropriate workup
Off pathway, treat appropriately
Consider neurologic consult, off pathway
Will require psychiatric admission?
Admit to psychiatric facility
Potential medical reasons for behavior/psychiatric emergency
Medical clearance laboratory workup should be individualized to the patient's symptoms. Although most testing in medically-asymptomatic patients is not useful, 'higher'-value tests commonly required by accepting psychiatric facilities are listed here.
AAEP De-escalation Workgroup's 10 key elements for verbal de-escalation