There are many reasons that a trauma patient may become combative. They include preexisting medical conditions such as diabetes or personality disorders as well as drug or alcohol intoxication or as a result of the head injury or of hypoperfusion. The physician will urgently search for and treat any medical, metabolic, or CNS structural problem that could be contributing to the combative behavior.
And rapid control of the behavior is necessary so that potentially lethal etiologies can be diagnosed and treated.
“Rapid tranquilization using haloperidol is well established as a safe and effective means for gaining control of the combative trauma patient who cannot be settled by other means. Haloperidol can be used intravenously in 5- to 10-mg increments every 5 minutes until a sufficient clinical response is achieved. There is exentsive literature supporting the safety of this approach.” (1)
If the combative trauma patient requires intubation, then rapid sequence intubation is indicated. But if the patient is combative and doesn’t appear to require intubation, then rapid tranquilization is indicated. In many cases, the correct decision will not be clearcut.
(1) Manual of Emergency Airway Management, 4th ed, 2012. RM Walls and MF Murphy. p. 354.