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Restraints are used in the healthcare setting primarily in two general situations: violent and/or self-destructive situations when the patient has demonstrated or poses an imminent danger to themselves or another, and disruption of therapy or non-violent, non-self-destructive situations. Chemical restraints are an effective and safe tool in caring for patients when used wisely. This chapter intends to provide an overview of the pharmacology, indications, side effects, and dosages of the three most commonly used medications for chemical sedation: lorazepam, haloperidol, and ketamine. Physical restraint application requires training and the demonstrated competency of involved staff. Alternatives to both chemical and physical restraints should always be explored before their initiation. Seclusion is another form of behavior control used in emergency departments and hospitals, and is simply defined as the confinement of a patient in a closed space for a specific amount of time.
Substance use is highly prevalent among patients presenting to emergency departments (EDs). Substance use complicates differential diagnosis of the ED patient, as substance use can mimic a variety of psychiatric syndromes. Chronic drug and/or alcohol use significantly increases the likelihood that a person will use an ED for medical treatment. The drugs of abuse and intoxication include alcohol, opiates, sedative hypnotics, stimulants, hallucinogens and dissociative agents, inhalants, and cannabinoids. Drug intoxication is commonly involved in ED visits, and patients may present with a variety of medical and psychiatric complaints. Drug intoxication complicates clinical presentation and can lead to prolonged ED length-of-stay, deployment of resources, including the use of restraints in severe intoxication syndromes, and creates a challenge for disposition and treatment.
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