Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Behavioural disturbance with physiological danger
Airway compromise, cyanosis, collapse, severe hyperthermia, seizure, head injury, fluctuating consciousness or extreme exertion during agitation or restraint is a medical emergency, whatever the presumed psychiatric cause.
Action: Stop unsafe restraint, call the emergency team and assess ABCDE with glucose, oxygen saturation, temperature and injury review. Provide resuscitation and cause-specific treatment, maintain trained observation and transfer to an appropriate acute medical setting without delaying care for diagnostic debate.
Synopsis
Manage escalating behaviour in mania through medical assessment, trauma-informed de-escalation and proportionate least-restrictive intervention, while recognising delirium, intoxication and post-restraint physiological emergencies that require immediate treatment.
First action is simultaneous safety and medical triage: acute agitation can arise from hypoxia, hypoglycaemia, delirium, intoxication, withdrawal, pain, head injury or mania.
Use one calm lead communicator, personal space, simple choices, reduced noise and stimulation, access to food, fluid and toilet, and known preferences or advance statements.
Verbal de-escalation and acceptable oral medication are preferred; as-needed medication alone is not a complete de-escalation strategy.
Key red flags
Stridor, respiratory depression, cyanosis, collapse, chest pain, severe hyperthermia, seizure or reduced consciousness requires immediate ABCDE management and resuscitation support.
Investigation priorities
01
Immediate ABCDE assessmentFirst step
Detect airway, respiratory, circulatory, neurological, glucose, temperature and exposure emergencies during disturbance.
Management branches
First actionDe-escalate while excluding emergency
A person with suspected mania becomes increasingly agitated but communication remains possible.
Call appropriate support, remove hazards and bystanders, reduce stimulation and nominate one calm communicator with safe personal space.
Offer simple choices, oral treatment and basic needs while checking ABCDE, cognition, injury, substances and the immediate harm scenario.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.