TBI-AGGRESSION OR AGITATION MANAGEMENT

SUMMARY

NON-PHARMACOLOGIC MEASURES
1. Reduce the level of stimulation in the environment:

- Place patient in quiet, private room
- Remove noxious stimuli if possible: tubes, catheters, restraints, traction
- Limit unnecessary sounds: TV, radio, background conversations
- Limit number of visitors
- Staff to behave in a calm and reassuring manner
- Limit number and length of therapy sessions
- Provide therapies in patient room

2. Prevent harm to self or others:
- Place patient in a floor bed with padded side panels (Craig bed)
- Assign 1:1 or 1:2 sitter to observe patient and ensure safety
- Avoid taking patient off unit
- Place patient in locked ward
- Use of equipment/devices: alarm and non-slip mats

3. Reduce cognitive confusion:
- Deconstruct complex tasks into smaller steps
- Communicate with patient briefly and simply, one idea at a time
- One person speaking to patient at a time
- Maintain staff to work with patient
- Minimize contact with unfamiliar staff
- Reorient the patient frequently: placing an orientation board with date, location, placing a clock, photos of family members
- Bowel and bladder care: timed toileting, avoid constipation, avoid overflow incontinence by titrating fiber in diet and aperients

4. Tolerate restlessness when possible:
- Allow patient to thrash about in floor bed
- Allow patient to pace around unit with 1:1 supervision
- Allow confused patient to be verbally inappropriate

PHARMACOLOGIC MANAGEMENT (CONTROVERSIAL)
5. Typical antipsychotics, atypical antipsychotics, beta-blockers, anti-convulsant medications, antidepressants, lithium, neuro-stimulants (amantadine, methylphenidate, dextroamphetamine), medroxyprogesterone

Reference(s)

Cifu, D.X. (2020). Braddom’s physical medicine and rehabilitation. Elsevier. Get it on Amazon.
Cuccurullo, S. (2019). Physical medicine and rehabilitation board review. New York: Demosmedical. Get it on Amazon.
O’Young, B., Young, M.A. and Stiens, S.A. (2008). Physical Medicine and Rehabilitation Secrets. Mosby. Get it on Amazon.