The Art of Managing Agitated Patients

Effective agitated patient management requires a fundamental shift from viewing these encounters as behavioral problems to recognizing them as medical emergencies with underlying pathophysiological processes. By systematically addressing safety, identifying root causes, selecting appropriate pharmacological interventions, and maintaining rigorous post-sedation monitoring, EMS providers can dramatically improve outcomes for these challenging patients. Remember: you cannot talk someone out of a hypoglycemic crisis, hypoxic emergency, or sympathomimetic overdose. When verbal de-escalation fails, it's not your failure as a provider—it's an indication that medical intervention is required to address the underlying pathophysiology driving the patient's agitation. The goal isn't just to control behavior—it's to provide definitive medical care that addresses the root cause of the patient's distress while maintaining safety for everyone involved.   Our guest is Patrick Hendley, a practicing paramedic and an expert in agitated patient management. We'll explore the pathophysiology behind agitation and essential strategies for EMS providers faced with these calls. We'll also examine sedation choices, restraint use, and post-sedation care through a lens of real-world EMS principles. Join us as we look at more than just de-escalation, but understanding and acting effectively and ethically to safeguard everyone involved.   Don't forget to check out our sponsor, The Resus Tailor, for custom bag designs tailored to your EMS needs. Reach out to them at theresustailor.com.    00:00 Introduction to Loud and Clear EMS 00:27 Today's Topic: Managing the Agitated Patient 01:00 Guest Introduction: Patrick Henley 02:17 Sponsor Message: The Recess Tailor 03:01 Case Study: Agitated Patient Scenario 06:04 Understanding Agitation and Safety Principles 08:12 Sympathetic Nervous System and Agitation 10:00 Factors Contributing to Agitation 13:02 Drug Influence on Agitation 19:05 Safety Hierarchy in EMS 30:34 Transport Safety and Patient Management 33:07 Treating Underlying Causes of Agitation 39:08 Managing Patient Anxiety with Fentanyl and Oxygen 39:45 Using Ketamine for Pain Control and Sedation 40:25 Addressing Mixed Presentations: Schizophrenia and Substance Use 41:38 Treating Sympathomimetic Overdose and Psychosis 42:56 The Importance of Post-Sedation Monitoring 43:51 Verbal De-escalation and Benzodiazepines 45:00 Using Time as a Tool for Postictal Patients 46:11 Understanding Benzodiazepines and GABA Receptors 47:59 Antipsychotics and Ketamine: When Benzos Aren't Enough 59:17 The Role of Physical Restraints in Patient Management 01:08:43 Effective Handoff and Continuity of Care 01:18:11 Final Thoughts and Core Principles   Resources The Resus Tailor - https://www.theresustailor.com/ The Art of Managing Agitated Patients Supplemental Blog Post - https://emspodcast.com/the-art-of-managing-agitated-patients/ Gear We Like Books we recommend -  The Dichotomy of Leadership - https://amzn.to/4fiCAjN Extreme Ownership - https://amzn.to/3O1FWfa  Managing the Unexpected: Sustained Performance in a Complex World -        https://amzn.to/3V7BwYf Thinking Fast and Slow - https://amzn.to/4fiJG85 A Thousand Naked Strangers: A Paramedic's Wild Ride to the Edge and Back -  https://amzn.to/3YJJrf2 Good Stethoscope - https://amzn.to/3YJJrf2 Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn  Notepad for taking notes on calls - https://amzn.to/3Z1X21J Sunglasses - https://frontline-optics.com/discount/EMSCAST15 Guest/Cast/Crew information- Guest- Patrick Hendley Host- Ross Orpet, Will Berry  Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: emspodcast.com/free-coaching-call 📰 Join our weekly newsletter for exclusive EMS insights, leadership strategies, real-life scenarios, and tools designed to help you stay sharp, confident, and ahead of the curve: https://loudandclear.kit.com/d45b012fae American Burn Association / ABLS: Enter the ABLS giveaway by June 30, 2026; the winner will be selected July 1, 2026. Loud & Clear listeners also get 10% off ABLS Now through August 31, 2026. Details: https://bit.ly/aba-loud-clear