Rapid Sedation (Rapid Tranquillisation)
Definition and scope
Rapid tranquillisation refers to parenteral medication-usually intramuscular (IM)-used to achieve prompt control of an acutely agitated, violent or behaviourally disturbed patient when verbal de‑escalation has failed and there is an immediate risk to the patient or others. Intravenous (IV) sedation is only used in exceptional circumstances.
National guidance separates general rapid tranquillisation in mental‑health/ward/community settings (NICE NG10) from emergency‑department management of severe acute behavioural disturbance (ABD, “excited delirium”), where different agents and a resuscitation‑capable environment are often required (RCEM). Follow the guidance pathway appropriate to your setting and local trust policy (NICE NG10; RCEM 2023).
Indications Use rapid sedation when all of the following apply:
- The patient lacks capacity or refuses treatment and poses an imminent risk to themselves or others.
- The agitation is severe, violent or likely to cause serious harm.
- Non‑pharmacological strategies (verbal de‑escalation, containment, environmental measures) have failed or are inappropriate.
- A safer managed environment cannot otherwise be ensured.
Agent selection - principles Choose agents based on the setting, likely cause of agitation and patient factors:
- Consider aetiology: primary psychiatric illness, stimulant intoxication, alcohol withdrawal, metabolic disturbance, infection, head injury.
- Consider co‑intoxication (alcohol, opioids, stimulants), cardiorespiratory disease, known QT risk, previous response to medication, pregnancy, age and frailty.