Musculoskeletal, Neurological, Behavioral/PsychosocialDifficulty 2/5
A previously calm ventilated patient becomes acutely agitated overnight. What should be assessed first?
- AApply physical restraints and reassess in the morning with the day team
- BRequest an urgent psychiatric consultation for the behavioural change
- CIncrease sedation to protect the airway and prevent self-extubation
- DScreen for hypoxaemia, pain, bladder distension and withdrawal first
Show answer and rationale
Correct: D. Acute agitation is a symptom. Hypoxaemia, pain, urinary retention, withdrawal and metabolic causes must be screened before sedation, which would otherwise mask a treatable deterioration.
- C — Sedating first can conceal hypoxaemia or another emergency.
- A — Restraints do not diagnose the cause and carry their own harms.
- B — A psychiatric cause is a diagnosis of exclusion in a ventilated ICU patient.