In the management of acute severe agitation in the emergency department, which combination is recommended by evidence-based protocols for rapid tranquillisation when oral medication is refused?
- A IV diazepam + IV phenytoin
- B IM droperidol or IM olanzapine alone (avoiding concurrent IM benzodiazepine) ✓
- C IM olanzapine + IM benzodiazepine (combination)
- D IV chlorpromazine + IM promethazine
Correct answer: B. IM droperidol or IM olanzapine alone (avoiding concurrent IM benzodiazepine)
Explanation
Current evidence-based guidelines (RANZCP, BAP) recommend IM droperidol or IM olanzapine as first-line for rapid tranquillisation. Critically, IM olanzapine should NOT be combined with IM benzodiazepine due to risk of serious cardiorespiratory depression and death. If a benzodiazepine is needed, IM lorazepam can be used with haloperidol (not olanzapine). Droperidol monotherapy is highly effective and has a favourable safety profile in this context.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.