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Review 5: Intramuscular Midazolam, Olanzapine, Ziprasidone, Or Haloperidol For Treating Acute Agitation In The Emergency Department

Reviewers

Benjamin Schnapp, MD, MEd

Assistant Professor, BerbeeWalsh Department of Emergency Medicine, University of Wisconsin
Madison, WI

Shannon Burke, MD

BerbeeWalsh Department of Emergency Medicine, University of Wisconsin
Madison, WI

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1. Article Citation
2. Synopsis
3. ABEM Quick Quiz
4. Discussion
5. Critique
6. References
7. Editor’s Note
8. ABEM Quick Quiz Answers
9. Key Points
10. Original Article

Article Citation

Klein LR, Driver BE, Miner JR, et al. Intramuscular midazolam, olanzapine, ziprasidone, or haloperidol for treating acute agitation in the emergency department. Ann Emerg Med. 2018;72(4):374-385.

Synopsis

In the emergency department (ED), patient agitation can put the safety of the patient and the medical team at risk, and must be addressed quickly. This prospective observational study compared intramuscular (IM) haloperidol, midazolam, olanzapine, and ziprasidone for the management of agitation. Agitation was assessed using the Altered Mental Status Scale (AMSS) score. The primary outcome was the AMSS score at 15 minutes after medication administration. Secondary outcomes included the median difference in AMSS scores from baseline to 15 minutes, rescue medications administered, and adverse events. This study found that midazolam resulted in a significantly greater proportion of patients adequately sedated at 15 minutes compared to the other medications, with the exception of olanzapine, which was also found to be effective. Adverse effects were generally uncommon, and the occurrence of adverse events was not significantly different between the medications.

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