A medically ill patient develops acute severe agitation in the ICU. He is pulling at IV lines and is unable to cooperate. He has no prior psychiatric history. After de-escalation fails, pharmacological management of choice is:

• A IM olanzapine + IM lorazepam combination
• B IV droperidol 2.5 mg
• C IM ketamine 4 mg/kg
• D IV haloperidol 5 mg ✓

Explanation

IV haloperidol is the preferred agent for acute agitation in medically ill ICU patients due to its efficacy, well-characterized safety profile, and availability of the IV route. Combining IM olanzapine with IM lorazepam is contraindicated due to risk of respiratory depression and cardiac arrest. IV droperidol is effective but carries QTc prolongation risk and is less available. Ketamine at high doses causes dissociation; lower sub-dissociative doses are emerging but not standard first-line.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.