Significant behavioural issues
The aggressive, violent or challenging patient on a medical ward, finding the medical cause, de-escalation, safe sedation with droperidol, midazolam and olanzapine, restraint and the law, and patients who decline care or try to leave.
Tier 1Approach to a presentation
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Aggression on a medical ward is a symptom. The commonest causes are delirium, intoxication or withdrawal, pain, and dementia.
- De-escalate first. Most episodes settle without drugs or restraint.
- Use oral drugs where possible. For severe agitation in the ED, droperidol or midazolam IM, chosen by cause and setting.
Loading the rest of the note…
Finished reading?
Sources
- Therapeutic Guidelines: Psychotropic (acute behavioural disturbance)AU/NZTherapeutic Guidelines Limited, 2025
- Violence and aggression: short-term management in mental health, health and community settings (NG10)National Institute for Health and Care Excellence, 2015
- Isbister GK et al. Randomized controlled trial of intramuscular droperidol versus midazolam for violence and acute behavioral disturbance: the DORM study. Ann Emerg Med 2010;56:392-401AU/NZAnnals of Emergency Medicine, 2010
- Taylor DM et al. Midazolam-droperidol, droperidol, or olanzapine for acute agitation: a randomized clinical trial. Ann Emerg Med 2017;69:318-26AU/NZAnnals of Emergency Medicine, 2017
- Calver L et al. The safety and effectiveness of droperidol for sedation of acute behavioral disturbance in the emergency department. Ann Emerg Med 2015;66:230-8AU/NZAnnals of Emergency Medicine, 2015
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Deploy to Cloudflare on push to main