De-Escalating Acute Agitation: Safety- Strategy & Medication Insights
In Episode 1.5 of Psychiatry Boot Camp, we tackle one of the most high-risk and high-pressure situations in clinical psychiatry: the management of acute agitation.
Whether in the emergency room, inpatient unit, or community setting, clinicians frequently face patients who are escalated, dysregulated, or aggressive. Managing these moments requires clear thinking, evidence-based strategy, and a calm, structured approach.
Joining us is Dr. Tony Thrasher, President of the American Association for Emergency Psychiatry and Medical Director of Crisis Services in Milwaukee County. He is a nationally recognized leader in behavioral emergency care, with extensive experience training multidisciplinary teams on de-escalation and psychiatric crisis management.
🧠 In This Episode, You’ll Learn:
✔️ What defines acute agitation and how to recognize early signs
✔️ Core principles of scene safety and risk reduction
✔️ Verbal de-escalation techniques that actually work
✔️ How to use body language and tone to defuse tension
✔️ Indications and options for emergency pharmacologic intervention
✔️ Choosing the right medications: antipsychotics, benzodiazepines, or both?
✔️ Ethical and legal considerations when using restraint or seclusion
✔️ How to protect patients and staff while preserving dignity
📌 Why This Topic Matters:
Acute agitation can escalate into violence or trauma within seconds. How we respond in those moments reflects not just our clinical skills, but also our empathy, training, and understanding of trauma-informed care.
Dr. Thrasher provides a structured roadmap to managing these high-intensity encounters while minimizing harm. His guidance helps clinicians develop confidence in:
Identifying agitation early
Responding with appropriate levels of intervention
Understanding when (and when not) to use medication
Communicating clearly across teams in crisis moments
👨⚕️ About Dr. Tony Thrasher:
• President, American Association for Emergency Psychiatry
• Medical Director, Crisis Services – Milwaukee County Behavioral Health
• National trainer and speaker on psychiatric crisis intervention
• Advocate for improving safety and outcomes in emergency psychiatry
Dr. Thrasher is known for delivering practical, no-nonsense guidance grounded in clinical experience and supported by the latest research in behavioral health emergencies.
🎯 Who Should Watch This Episode:
• Psychiatry and emergency medicine residents
• Nurses, social workers, and crisis intervention teams
• Hospital staff working in psych emergency or consult-liaison roles
• Behavioral health clinicians in inpatient, outpatient, or forensic settings
• Anyone managing patients at risk for escalation or violence
This is a must-watch for teams and individuals looking to improve their confidence and coordination when dealing with acute behavioral disturbances.
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💬 Join the Discussion:
What strategies have worked for you in calming an agitated patient? How does your team handle behavioral emergencies? Drop your thoughts, stories, and suggestions in the comments below.
📌 Timestamps:
00:00 – Introduction to Agitation Management
02:15 – Recognizing Early Signs of Escalation
05:30 – Verbal De-Escalation: Words That Work
09:00 – Medical and Legal Principles in Emergency Psychiatry
13:20 – Pharmacologic Strategies and Rapid Tranquilization
17:00 – Safety Protocols and Staff Coordination
21:10 – Final Reflections from Dr. Thrasher
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