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FOCUSED SHIFT VIEW

Agitation & Suicidal Ideation

Medical first — then safety, then psychiatry.

Open full pathway
Educational first-pass aid. Reassess the patient, confirm doses and use local protocols.

1 · First minutes

  1. Glucose, SpO₂, temperature, and a toxidrome exam first — agitation is medical until those are done.
  2. Then safety: means, environment, 1:1 observation — no gaps for imaging or the toilet.
  3. Ask directly about suicide. Asking does not plant the idea.

2 · Escalate now if

  • Stated intent with available means
  • Attempt within the last days to week
  • Psychotic symptoms or command hallucinations
  • Intoxication with ongoing access to means
  • Discharge from psychiatric care in the past month
  • Inability to engage in a safety plan, or no safe person to go home with

3 · Immediate workup

  • Glucose, SpO₂; breath alcohol when relevant
  • Environment: remove ligatures/sharps; 1:1 observation for high risk

4 · Don’t miss

  • Active suicidal intent with a plan and access to means
    Constant observation now; remove means; do not leave alone for imaging, the toilet, or a smoke break.
  • Recent attempt
    Medical stabilization first (paracetamol/salicylate levels in every intentional overdose). The repeat-attempt window is highest in the following weeks to months, and after psychiatric discharge.
  • Agitation from a medical cause
    Hypoxia, hypoglycemia, encephalitis, serotonin syndrome, sympathomimetics, DTs, head injury, thyrotoxicosis — treat these before a psychiatric label. Verbal de-escalation, then medication; restraint only per protocol with monitoring.
  • Agitation with violence risk
    Safety of staff and patient; medical workup proceeds in parallel, not after the patient is “medically cleared” as a checkbox.

5 · Disposition lane

Admit (psychiatric, after medical clearance)

Active ideation with plan, attempt survivors, high risk with insufficient supports — per local mental-health law (voluntary/involuntary).

Emergency psychiatric hold + security

Imminent danger to self/others, agitation requiring restraint protocols, refusal of care with impaired capacity.