Screaming Patient, No Restraints

By Scott Zeller, MD: For Complete Post, Click Here…

When possible, rather than just assuming everybody needed to be involuntarily medicated, maybe we could talk to people and help them to calm down, and use techniques like verbal de-escalation, and try to engage with them and create what we call a therapeutic alliance. Encourage them, if we thought medications were indicated, that we would give them the medications willingly and that we would give them to them as a pill with a glass of juice as opposed to holding them down and giving them an injection. I think that that kind of led to the basis of both EmPATH and EPI. That was kind of that kind of philosophy, what we would often call like the six goals of emergency psychiatry.

One day really kind of changed everything that showed that this was possible, even in a case that everybody assumed it was just out of bounds, we had a young man come in who was screaming non-stop. He was there with an ambulance and police. They brought him into the triage of the hospital emergency department, and he was just screaming, “Ya, ya, ya.” They came to me and said, “Dr. Zeller, could you prescribe some sedation medication for this guy? He’s really acutely psychotic. He’s screaming non-stop. He really needs medicine. We need to give him some forcible injections right now.”

I was saying, “Well, did you ask him if maybe he might be willing to take some meds by mouth? Is he somebody who’s willing to engage?” They said, “I don’t think you understand. He’s screaming non-stop.” I said, “Well, let me go and see.” So I went into the room that he was restrained to the bed in and saw the patient, and there he was, sure enough, “Ya, ya, ya.”

I said, “Sir, when you’re having a tough time like now, is there a medication you might want to take that would help you?” He went, “Ya, ya, ya.” Then he stopped and he told me the name of the medicine that would help him. Then he went right back to screaming again, “Ya, ya, ya.”

I said, “OK. Would you be willing to take that medicine if I brought it to you?” And he kept screaming, “Ya, ya, ya.” And he nodded his head, and so I went out and told the staff. I wrote an order and said, “Would you bring him this medication and a cup of juice?” They looked at me dumbfoundedly, but they went ahead and did it.

They brought him the medicine, and sure enough, he took the medication and swallowed the pill with a cup of juice, and about an hour later he was doing much better, and so I went to see him, and he was now calm. He wasn’t screaming any longer.

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