The Case of a Violent Agitated Patient in The Emergency Department

This is a staged re-created photo of a true case that happened weeks before.  A 24-year-old male patient, who was at a party using meth and cocaine, restrained by police at the scene and brought to the ED fighting and screaming. He was hyperthermic, with a temperature of 105 degrees on arrival.  EMS attempted to place the patient on his side, but he was too combative, and so he was restrained using 4-point soft key-less restraints (one wrist high, one at waist level, to prevent him from sitting up or head-butting anyone).  Doctors are assessing this patient, taking care to not be struck or head-butted, while nurses obtain vital signs, pulse oximetry and capnography readings, IV access, and eventually give medications and IV fluids.  Security Officers assist in patient restraint.

Nurse is administering ketamine IV push to sedate the patient for his own safety, and that of the hospital staff.

Medication is taking effect. The patient is not fighting, and his lactic acidosis and hyperthermia are improving. IV fluids were started and resuscitation continued, monitoring patient continuously. He was soon admitted to the intensive care unit for further care.

Photos provided by Dr. John Wipfler