Managing acute psychosis – haloperidol vs. olanzapine in the ED?

For acute agitation I typically use droperidol or haloperidol IM — fast onset, reliable. Olanzapine IM is also effective but avoid combining it with benzodiazepines due to respiratory depression risk. Get an ECG if you can.

Our ED protocol uses haloperidol 5mg + lorazepam 2mg IM (B52). For excited delirium or if substance use is suspected, ketamine IM is increasingly used for rapid control. Always have resuscitation equipment ready.