What is the best approach for parenteral sedation to manage severe acute behavioral disturbance in the emergency department?

There is a good evidence base to recommend a standardized approach to the management of severe acute behavioural disturbance in the emergency department. We recommend using intramuscular droperidol (or olanzapine if droperidol is not available) as a first-line therapy, which can be repeated at 15 min if effective sedation is not achieved. If rescue sedation is required or in extremely dangerous scenarios when immediate control is required, we recommend ketamine. We do not routinely recommend benzodiazepines as first-line therapy, unless specifically treating a condition likely to benefit from benzodiazepines, such as alcohol (or sedative hypnotic) withdrawal or stimulant intoxication. We do not recommend combination therapy (antipsychotic and benzodiazepines).