Violent Behaviour in the ED – Post Test

A patient with a swollen and painful right hand is in the waiting room, demanding to be seen immediately. He is clearly drunk, using foul language and threatening the reception staff. You are asked to intervene. The best approach is…

A 19-year-old profoundly autistic patient presents with his caretakers. He has sustained a deep contaminated wound to his thigh which needs cleaning and suturing. You can see obvious debris in the wound. He physically resists any attempt to manage him, lunging at staff who try to approach him.

Your approach should be

A 20-year-old man is brought to the department by police. He is handcuffed and has suffered a slash wound to his face. The wound needs careful suturing. Police advise you that he is drunk and has assaulted a number of people in a bar fight. The patient is compliant, polite and engages you in coherent conversation. He is respectful to you but clearly unhappy with the police. He demands to be released from the handcuffs and insists that he be treated without the police in attendance.

You decide to:

A 29-year-old woman has come to a meeting to complain about the management of her father who died in your department. She raises her voice and starts to list a number of her observations, most of which are clearly erroneous.

The best way to manage this is to:

You are alone in a treatment room with a 19-year-old man, he has reluctantly consented to your suturing a wound on his chest which he sustained climbing a fence. He has been angry and quite a handful with the nursing staff. He raises his voice, has a red, angry face, he is gesticulating wildly and from time to time engages in prolonged eye contact with you.

You should:

You are alone in the treatment room with a 19-year-old who has reluctantly consented to you suturing a superficial wound on his chest which he sustained climbing a fence. Observations and physical examination are normal; there is no evidence of a penetrating chest wound. He has been angry and quite a handful with the nursing staff. He was initially shouting, had a red angry face, was gesticulating wildly and engaged in prolonged eye contact with you. He is now quiet, not responding to you and sits up glancing at your chest and he seems withdrawn. He is no longer shouting; his face is pale.

You should:

An agitated and dishevelled, 40-year-old woman is brought by ambulance, after being found fully-clothed in a public park. No other history is available. She does not smell of alcohol. She is easily arousable to verbal commands but appears disorientated . She lashes out at staff trying to take her vital signs and conduct other observations.  Her blood pressure is 130/90 mm Hg, pulse is 78 beats/minute, respiratory rate is 13 breaths/minute and her temperature is 35⁰C. There is no medic-alert bracelet. There are no obvious signs of injury. She has a GCS of 12 [E3, M5, V4]. Her pupils are 2 mm, equal and reactive. Her rapid bed side glucose is 5.1 mmol/L. As you evaluate her chest she strikes you hard with her right hand and tells you to leave her alone, [that]  she ‘just wants to sleep’.

Your actions should be:

A known 56-year-old female psychiatric patient presents to the emergency department. She is agitated, obviously delusional and tells you that the ‘dead people are talking to her’. She is very violent at intervals, poses an immediate threat to staff and to patient safety. Security staff are restraining her. You decide to provide sedation to her.

Your choice for sedation should be

When deciding to use force of any kind on a patient, (e.g. to prevent assault, safeguard patients, staff and visitors, or rescue another person from assault), in order for that force to be lawful, it must: