Prehospital drugs for sedation in psychomotor agitation, friends or foes? An observational retrospective study
1Department of Anesthesia and Intensive Care Medicine, ASUFC University-Hospital of Central Friuli, 33100 Udine, Italy
2E.M.S.-SUEM-118, AULSS 1 Dolomiti, Pieve di Cadore Hospital, 32044 Pieve di Cadore, Italy
3Epidemiology and Public Health Unit, ASUFC University-Hospital of Central Friuli, 33100 Udine, Italy
4Department of Anesthesia and Intensive Care Medicine, A.O.U.I. University Hospital of Verona, 37126 Verona, Italy
5Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
DOI: 10.22514/sv.2023.110 Vol.19,Issue 6,November 2023 pp.160-167
Submitted: 14 March 2023 Accepted: 26 April 2023
Published: 08 November 2023
Altered mental status (AMS) describes an undifferentiated presentation of disorders of mentation. It represents a common problem for prehospital and hospital providers and may be found in 5% to 10% of patients admitted to the Emergency Department (ED). Psychomotor Agitation (PMA), a state of motor restlessness and mental tension associated with a variety of psychiatric conditions, is one of the most frequent manifestations of AMS. In this observational retrospective study we included all the patients who presented PMA, treated by the out-of-hospital Emergency Medical System (EMS), and transported to the ED of the University Hospital of Udine, Italy. The objectives were to determine the incidence of patients with PMA treated by EMS in the area of investigation, the evaluation of pharmacologically treated patients considering the most commonly administered drugs, the intubation rate, the fraction of inspired oxygen (FiO2) needs, the length of hospital stay (LOHS), the adverse drug reactions (ADRs), and the excited delirium syndrome (ExDS). From January 2017 to December 2018, 319 patients were enrolled. The prevalence of PMA was 2.5% and 0.5% were the cases of PMA managed by the EMS. The predominant drugs used for sedation were midazolam (19.75%) and ketamine (9.09%), alone or in association; patients with consistent PMA required more than one sedative. Statistically significant differences were found in FiO2 supplementation for ketamine-sedated psychiatric patients and midazolam-sedated psychiatric patients with chronic home therapy, in the LOHS >24 hours (h), with a longer stay in case of midazolam and ketamine use, and in LOHS and FiO2 supplementation due to polypharmacy administration with more than one sedative drug. PMA is a frequent and widespread phenomenon and in the prehospital setting requires rapid assessment and management. Therapeutical strategies with benzodiazepines, ketamine, and rarely associations of drugs are safe, do not increase hypoxia and intubation rate.
Psychomotor agitation; Ketamine; Midazolam; Emergency medical system; Prehospital care
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