Comparative study of Intramuscular Midazolam, Lorazepam and Haloperidol-Promethazine combination for management of acute agitation.

In the event that the patient meets the study’s eligibility requirements, socio-demographic and  clinical profile and the baseline AMSS score will be gathered. CAM would be applied to filter  out patients with delirium. Computer generated number will be used for randomization. Each patient would either receive 5mg midazolam or 2mg lorazepam or 5mg haloperidol and 50 mg promethazine combination.  Time to adequate sedation (defined as AMSS score less than/equal to 0) will be recorded with a stopwatch.  Occurrence of bradycardia (Pulse Rate <60 beats per minute), extrapyramidal adverse effects  (akathisia or dystonia), allergic reactions (rash, wheezing, or anaphylaxis), hypoxemia (oxygen  saturation <93%), or intubation will also be noted.Patient would be followed up till 12 hours after the intramuscular injection has been given.  AMSS score would be calculated at 0, 30 min, 1 hour, 6 hour and 12 hour mark. Blood pressure,  pulse rate, oxygen saturation and AIMS score (for extrapyramidal symptoms) would also be  noted. In case the patient continues to have disruptive behavior at 30 minutes after first dose, repeat dose of same agent, that is, 5mg midazolam or 2mg lorazepam or 5mg haloperidol and 50 mg  promethazine combination, will be considered and documented. If the patient remains  disruptive at 1 hour mark or after 2 injections, it will be considered as “failure to sedate”,  however management will continue as standard care. If repeat dose of sedative is given up till 12 hours after adequate sedation is once achieved, it  will be documented. Comparison between 3 subgroups regarding time of adequate sedation and need for repeat  sedation will be done. After the end of study period, that is 12 hours, treatment as usual will resume.