Question: What’s the best “cocktail” to take down an aggressive psychotic patient? (Psst, cocktail does not mean alcohol. Bummer, I know.)
Fantastic question, Bethany!!!
Working in the psych ER, I had lots of opportunities to tackle this very situation. It’s especially exciting at 3 AM when you’re jacked from too much coffee, half-delirious from lack of sleep, your eyes burn from the ever-so-flattering fluorescent lighting, and your teeth feel like they’ve got hair growin’ on ’em. (Yeah, you probably didn’t need that visual).
Anyway, imagine a eerily silent unit, where the only sounds include the buzz of electronics, the clicks of fingers typing, and the snoring of patients. Your eyelids slip down, hindering your sight as you try to write up your most recent case.
A bang snaps your spine to attention. This is followed by a yell. Then a scream. Finally, the pounding of slippered feet echoes down the hallway. The guy you evaluated six hours ago (and who is waiting for a hospital bed), can’t keep it together any longer. He’s certain you’re a part of the FBI conspiracy against him. He KNOWS you’re working with his psychiatrist to kill him. And he’s going to do something about it. NOW.
In a fit of fury, he rips a cabinet off the wall. Smashes a table to smithereens. He takes the cabinet door as a shield and a table leg as a club.
You call security to announce a code. The staff needs back-up to handle this guy. Within thirty seconds, about a dozen big fellas show up.
You try to talk the guy down.
He’s not interested. And there ain’t no rationalizing a paranoid person out of their delusion (believe me, it’s part of the definition).
You tell the nurse to draw up Haldol (AKA haloperidol, an anti-psychotic/major tranquilizer) and Ativan (AKA lorazepam, an anti-anxiety medication with calming effects) in a syringe.
The staff negotiates with the patient to encourage him to cooperate.
He refuses. Swings the table leg/club. Security guards surround him. Remove his makeshift weapons and ease him to the floor. The medications you ordered are injected in his gluteus maximus and he’s walked to his room.
The experience is frustrating for the patient. He paces for a minute, yells at the staff members who are keeping an eye on him so he doesn’t rampage the unit more. In about ten to fifteen minutes, he gets sleepy, flops down on the bed, and goes to sleep.
For several hours.
You complete your shift, envious that someone is sleeping.
Disclaimer: This is NOT intended as medical advice or treatment. This is solely for the purposes of writing.
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