Question 2 of 33

A 32-year-old man is standing in the hallway of the emergency department cursing loudly and screaming that no one is paying attention to him. One of the nurses recognizes him from another hospital as someone who frequently is admitted for psychiatric illness. Your initial action is to:

Introduce yourself and ask him how you can help him today.

Call hospital security and place him in four point restraints.

Ignore him.

Order the nurse to give him ziprasidone 10 mg IM.

Order the nurse to give him lorazepam 2 mg PO.

If a patient is potentially dangerous, but not in need of immediate restraint, a psychiatric interview should take place in an open area with nearby security personnel. The physician should begin with an introduction and express the desire to help the patient. If sedation is necessary, haloperidol is the most widely used drug rapid tranquilization, although the recently approved atypical antipsychotics ziprasidone can be an alternative. Many physicians also use droperidol, but the FDA has now issued a warning against the use of this drug based on reports of adverse cardiovascular events including cardiac arrest and torsade de pointes. Lorazepam and other benzodiazepines may be used as adjuncts to neuroleptics for rapid tranquilization. For violent patients, temporary use of physical restraints may be necessary while rapid tranquilization is initiated.