b'ChapterHow to Recognise and ManageHow to RecogniseSigns and symptoms are highly variable and include:Increased arousal (agitation, excitation, restlessness, pacing, fearful, wringing hands,screaming, yelling, frightened, frantic).Rigidity, (an indicator of intense effort to control themselves)Abnormal or unusual thinking, perception, or ideas (hallucinations)Inappropriate clothing for the climate or contactAltered conscious state.Aggression, violent, argumentative, or bizarre behaviour.A severe and partially life-threatening form of behavioural disturbance is present when thepatient has:An elevated body temperature, (hot to touch or sweating profusely)Insensitivity to pain (may be walking with a broken leg or severe injury)Rapid breathing rate, Rapid heart rateExtreme arousal including aggression and or violenceHow to ManageThe initial approach to a patient with agitation / behavioural disturbance should be focused onpotential danger. Ensure safety of first aiders, others, and the patient.De-escalation strategies are extremely difficult without training and experience. They can exacerbate the situation if not performed properly and should not be attempted unless trained and skilled at the technique.Ensure your safety and the safety of othersseek appropriate support and assistance early(ambulance, security services, police, mental health professionals).If the person deteriorates or becomes unconscious, manage the person / apply DRSABCDReassureempathise and listen actively if it is safe and trained to do so.Listen closely and carefully.Remain non-judgementally to what the person is saying and feeling.Seek advice or assessment from a healthcare professional.262 The Agitated Patient'