2024-2025 Evidence-Based Protocols
From Containment → Active Treatment
EMTALA requires STABILIZING treatment, not just holding
| Tool | Application |
|---|---|
| C-SSRS | Suicide risk: passive vs active intent |
| BVC | Violence: Score >2 = high risk |
| SMART | Medical stability (not clearance) |
1. Respect personal space
2. Don't be provocative
3. One leader, one message
4. Be concise
5. Identify wants/feelings
| Status | Intervention |
|---|---|
| Cooperative | Oral: Risperidone, Olanzapine ODT |
| Uncooperative | IM Droperidol (preferred) |
| Refractory | Ketamine 4-5mg/kg IM |
Alcohol: Phenobarbital 10mg/kg IV load (auto-tapers)
Opioid: Buprenorphine 8-16mg SL (macrodosing)
| Feature | NMS | Serotonin |
|---|---|---|
| Onset | Slow | Rapid |
| Muscle | Lead pipe | Clonus |
| Tx | Dantrolene | Cyproheptadine |
1. Active treatment, not containment
2. Use BVC, C-SSRS, SMART
3. Project BETA de-escalation
4. Phenobarbital for alcohol withdrawal