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Always Try De escalation First
- Prioritise de-escalation before restraint or drugs unless there's immediate danger.
- Use environment, single-person calm contact, short sentences, validate feelings and offer limited choices to reduce agitation.
How To Conduct A Safe De escalation
- Structure de-escalation: optimise environment, keep arm's length, use one calm communicator, repeat short sentences and listen for needs.
- Involve calm family selectively and change communicators if engagement fails.
Restraint Can Exacerbate The Metabolic Storm
- Restraint can worsen ABD by increasing catecholamine surge, metabolic acidosis and hypoxia, potentially precipitating sudden collapse.
- The interaction between restraint and ABD pathophysiology is complex and may itself exacerbate deterioration.