Aggression

We had a patient yesterday that was agitated and then escalated to the point that he required the police to intervene and rescue a nurse (patient had her in a choke hold).  This can be avoided if the agitation is identified and effectively dealt with before it escalates to the point of no return.  The first thing that happens when a patient starts yelling and showing his/her fists is a bunch of people like to gather around to help.  Unfortunately this is the worst scenario for the patient because it now looks like a mob (all against the patient) and makes the situation even worse.  It creates more noise and an over-stimulating event.  The patient feels more threatened then ever and the patient loses.  A better scenario is to try to re-direct the patient into a calm environment like his/her room with just a 1-on-1 conversation.  Speaking very calm and as little as possible.... using slow deliberate movements and avoid direct eye contact as this can also escalate anxiety/anger.  Try to touch the patient as little as possible until he/she calms down.  Music is often helpful (something calming) or certain scents like peppermint, cinnamon, lavender, or vanilla are also very effective for calming effects.  You can use a stimulation such as a taste like a peppermint candy or butterscotch.  Giving a heavy blanket or pillow for him/her to hold on to is also calming.  The key is to catch the behavior before it escalates to the point of yelling...watch the person for aggressive talk, aggressive singing, frantic eye movements, shakiness, crying, or aggressive wandering (seeking a way out).  Intervene at the first signs and you'll have much better luck with your calming activities.