Humane Rapid Tranquilization of an Agitated Patient with an Implantable Cardioverter Defibrillator

A 76-year-old man with dementia and a history of cardiac issues, including an implantable cardioverter defibrillator (ICD), was admitted to a psychiatric ward due to agitation and personality changes. During his stay, an incident occurred where his ICD activated multiple times after a security guard attempted to retrieve crumpled clinical notes from his pocket. This led to a decision to use non-pharmacological methods, such as one-to-one nursing and verbal de-escalation, to manage his agitation, as medication posed a risk of dysrhythmias. Over a 5-week admission, his cognitive function improved, and his medication, amisulpride, was increased. He was discharged with support from care workers and community psychiatric services. A year later, he reported feeling well with some short-term memory issues, and his wife noted an overall improvement in his mental functioning.