Author: Steve Corry-Bass / Editor: Andrew Tabner / Code: CP2, MHP1, ResP2, SLO1, SLO3 / Reviewer: Steve Corry-Bass / Published: 16/01/2021 / Reviewed: 29/02/2024
A 19-year-old male has presented to the Emergency Department (ED) following an alleged assault whilst he was waiting to get into a nightclub. He is complaining of being ‘badly winded’.
He was brought to the department by the Police (he is under arrest) and is angry at having to wait to be seen. He denies any head injury or Loss of Consciousness. He has no Past Medical History / Medications / Allergies. He states he has “had a few”, and that he was assaulted for no reason, having his wallet and phone stolen.
The triage nurse has documented the following observations.
Temp – 35.9ºC
HR – 137 /minute
BP – 101/77 mmHg
RR – 24 / minute (shouting)
Sats – 83% (poor trace)
BM – 6.3mmol/l
Pupils – 6mm & reactive bilaterally
GCS – 15/15
His behaviour has escalated in the time it has taken for the triage nurse to find you, he is now being restrained by two police officers, shouting / swearing and being aggressive. He states that he is going to find the guy who did this and ensure that he “gets what he deserves” and is demanding to leave.
25 responses
Nice one…intoxicated patients are always tricky…
This is a very useful deterrent to ED doctors not to be complacent in assessing a aggressive and more often than not altered patient in the Emergency Department
Quite a common Scenario in the ED
Interesting case
very tricky cases all the drunk ones and yes do need to be thoughtful about discharging them without proper examination.
Thoughtful scenario on drunk and assaulted patients
frequent problem worth reminder
Good case, thank you.
always a good reminder for the busy A/e doctor
in busy EDs its very easy to ignore an abusive aggressiv patient. keep your focus and see what you can fix.
good case
Good case. Frequent issue in a busy ED.
Anger, aggression,complaints can often, if explored, reveal a patients real reason for AE attendance and sometimes a diagnosis. Thanks another helpfull learning session.
Yes, alcoholic patient are always very tricky and it is very easy to fall to the patient ‘is drunk and is just being anti-social’
Interesting case
Interesting read – always remember that history taking is extremely important – need to consider that winded his chest could increase a risk of pneumothorax – especially after consumption of alcohol. i wondered, could alcohol increases risk of pneumothorax?? its easy to judged an angry patient by its cover – but looks at the facts! Winded chest – always auscultated his chest if any sign of chest wall injury. its could actually save a patient life.
Interesting read – always remember that history taking is extremely important!! Always completed a full systemic examination on an intoxicated patient, regardless however intoxicated they are.
be very careful with alcoholic patients , they can have any systemic insult you name it , always thorough history & examination, irrespective how much distractive they are
Indeed, we do get drunk people in the department, almost always
and cause chaos and havoc.
Intoxicated, assaulted, aggressive and deteriorating – Well presented case.
very good case
Interesting read, always be on guard.
THANKS
Great learning
Great 👍