Violent psych patients - how do you handle them in your ED?

[wildlaurel]

I would like to hear about how various ED's handle violent patients (psychotic - not a patient you can reason with) in the ED? A patient who became so out of control that one of their family members was injured (by the patient) and a nurse was injured trying to get the family member away from the patient. A patient who was so out of control that after being tazed by the police 3 times they took the police's tazer away and finally went down after being wrestled to the ground by 8 or 9 people. It is such an unsafe situation for the patient, other patients, staff and the police!! I have never been so afraid at work until I saw this because I was afraid the patient was going to get a gun away from one of the officers.

So, how do other ED's handle this kind of situation? The patient will be with us for a while because the aggressive behavior makes it difficult to find placement.

[CheesePotato, BSN, RN]

Therapeutic intubation.Rock beats scissors, scissors cut paper, propofol trumps all.Mmhm.

[diprifan]

RSI...

[brainkandy87]

B.I.T.C.H. Therapy - Benadryl, Inapsine, Thorazine, Compazine, Haldol

[cheryl2365]

We deal with a huge population of MH patients. We only have one seclusion room so most of the time they are mixed in with regular ED pt's. They are there for days sometimes waiting for placement. For out of control MH pt's it's a B52 and restraints if needed.

[mmutk, BSN, RN, EMT-I]

In one hospital I worked at we had 2 'safe rooms'. Nothing but 4 walls and 2 secured metal doors. 1 door to the ER hallway and the other to the ambulance bay (for police transport). They worked ok, but it seemed to always make them more angry.

In the current place I work we have at least 1 armed security officer stand at the doorway the patient's entire ER visit. They are always there if the patient is drunk/psych and combative. However if things get ugly often time we have to jump in and assist because it can be 4-7 minutes for other officers to come help em.

[CrunchRN, ADN, RN]

Too bad they cannot install drop nets in the ED cubicle ceilings ....... Sometimes your only choice is too have enough overwhelming force to allow immobilization and control.

It is a difficult situation with no easy answers if you cannot talk them down and they insist on violence.

[wildlaurel]

Yeah - there was no reasoning with this patient - they were completely psychotic. Those people just scare me - I can take a mean drunk or a manipulative personality disorder - but psychotic people just cannot be reasoned with.

[brillohead, ADN, RN]

Why can't ER supply rooms have a supply of these things?

Martial Zoo Law – Zooillogix

[ctmed]

One facility I was at as an agency CNA... call an agency "sitter". Then, totally forget about patient. If patient gets agitated and CNA is unable to "redirect", call agency and ask for another CNA. Do Not Return (DNR) that other lame, incompetent one. Later, when you have been through all CNAs on the call roster , update your standards to only CNAs who have been trained in CPI, of course only out of thier own pocket or have previously worked psych and had someone else pay for it :)

[That Guy, BSN, RN, EMT-B]

50mg of elbow.