A recent study compared haloperidol, olanzapine, midazolam and ziprasidone to treat agitation in the emergency department setting. The doses used were haloperidol 5 mg, ziprasidone 20 mg, olanzapine 10 mg, midazolam 5 mg, and haloperidol 10 mg – primary outcome was the proportion of patients adequately sedated at 15 minutes. Midazolam resulted in a greater proportion of patients adequately sedated compared with ziprasidone (difference 18%; 95% confidence interval [CI] 6% to 29%), haloperidol 5 mg (difference 30%; 95% CI 19% to 41%), haloperidol 10 mg (difference 28%; 95% CI 17% to 39%), and olanzapine (difference 9%; 95% CI –1% to 20%). Olanzapine performed better than haloperidol 5 mg (difference 20%; 95% CI 10% to 31%), haloperidol 10 mg (difference 18%; 95% CI 7% to 29%), and ziprasidone (difference 8%; 95% CI –3% to 19%). 730 subjects were studied – there were no cardiac arrests, two people developed acute EPSE, five became hypotensive, 10 hypoxaemic and four required intubation (adverse events were not over-represented in any of the groups).
Effective management of behavioral emergencies is vital in hospitals, and this study is of great interest in regard to the safety or patients and staff. More available here.