ED Agitation, Imaging, and Injury: An Evidence Synthesis for Imaging Access in Agitated Trauma Patients

Background: Agitated adult trauma patients are common in Canadian emergency departments (EDs). Cooperation and monitoring constraints can delay essential imaging and risk missed injury. Objective: To synthesize current guidance and evidence into an educational framework for timely, safe imaging when the trauma exam is unreliable due to agitation. Methods: Narrative review using targeted searches of guideline/agency sources and peer‑reviewed trials/meta‑analyses on agitation control, eFAST, and selective versus whole‑body CT. Outputs were a conceptual evidence map and a worked case. Results: Current research prioritizes parallel resuscitation with early eFAST. Unstable, eFAST‑positive patients usually proceed to hemorrhage control rather than CT. For stable or stabilized adults with an unreliable exam, brief, monitored behavioral control (single, guideline‑supported regimen) creates a one‑trip imaging window under continuous SpO₂/NIBP/ECG (± capnography). Teams select an up‑front imaging approach: selective CT once cooperation returns and injuries localize (using CCHR/CCR where applicable), or whole‑body CT when multi‑region injury is likely or unreliability persists. The scanner‑side bundle includes named monitoring responsibility, an airway plan, and dose‑optimized protocols. Downstream steps include IR‑supported non‑operative strategies for eligible solid‑organ injury, a 24–48‑hour tertiary trauma survey, and a structured psychiatry handoff to limit re‑sedation. Conclusions: In agitated adult trauma, a single, monitored trip to obtain the necessary imaging after brief, guideline‑aligned behavioral control may improve safety and throughput. This educational synthesis requires local policy alignment and prospective evaluation.