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Letter to the Editor: Undifferentiated Agitation is Different …: Emergency Medicine News


It appears that a psychiatrist and an anesthesiologist are looking into the suitability of drugs administered by EMS to control undifferentiated agitation in a patient at the scene. (“Death of Black Man Prompts Reanalysis of ExDS”, REM. 2021; 43[10]: 1;

I am amazed that the psychiatrist said, “As psychiatrists, dealing with those who are out of control is our bread and butter. This statement will irritate in many ways any EP working in a busy urban center. When was the last time four officers, two doctors and several nurses from a psychiatric office or hospital ward had to detain a patient they had never seen, had no medical records or history, and who they had to make a decision about what to do next?

How many times has a PE detained a psychiatric patient in the emergency room for not being able to make it to the inpatient unit due to “agitation requiring sedation?” This happens all the time in my city. The psychiatric ward says it can’t handle patients who are so agitated and they have to stay in the emergency room until they are less agitated.

This hardly matches the claim that it is their bread and butter. And the anesthesiologist is worried about the dose? Too big? Oh good? Too small is the most common problem I see. Is there much in the toxicology literature supporting the dangers of double or triple dosing ketamine? If so, I did not find anything.

But why do we ask a person whose job it is to work in an operating room to deal with someone on the street with cops, handcuffs, sweating and screaming? It is as if the wars of “conscious sedation” are starting again. The house of emergency medicine must react forcefully when those who have no experience with our work tell them how to do this work.

Dave Eller, MD

Salt Lake City, Utah