Managing aggressive and violent patients

We have some concerns about the approach to sedation of patients with aggression and violence suggested by Professor Fulde and Associate Professor Preisz. Large numbers of patients require parenteral sedation with physical containment which can be hazardous to staff and requires a standardised approach. Recent research supports the use of different drugs and initial intramuscular sedation for most patients. One study demonstrated that the duration of acute behavioural disturbance was reduced when intramuscular sedation was employed. Intravenous sedation requires sufficient staff to restrain the patient, otherwise it is dangerous with the risk of needle stick or physical injury. However although intramuscular midazolam is used most commonly, recent evidence demonstrates that it is unpredictable due to over or under-sedation.