Best case ever.

Best case ever.

Yes, this is EMK's Best Case Ever, and I'm your host, Dr. Anton Helman. In anticipation of our upcoming episode on management of the agitated patient in the ED

is my pleasure to have back on EM cases, Dr. Rubin Strayer.

Dr. Strayer, let it rip.

Let's hear your best case ever related to the agitated patient.

The reason I think this is my best agitation case ever is because it's the one that got me interested in the topic.

It's the case that inspired me to spend a lot of hours reading and thinking about how to best manage agitation.

I used to work in a hospital that sees a lot, and I mean a lot of agitated patients.

On an overnight shift, it seemed like four out of five patients who came in to this emergency department were intoxicated or psychotic, often both,

and many of them brought in by

and being held down by teams of police and paramedics. The staff had evolved a strategy for managing

them over the decades, and most of the time this happened with little physician input. These patients

would come in being held down by five guys, and the nurses and techs would manage them in a fairly

uniform way and the doc often wasn't involved. That's not a critique by the way. We all agree that

the usual effect of adding a physician to a team of experienced nurses is to degrade care. But this

patient was really very agitated and so I walked over uninvited. He was a young man being held down by

five guys, and man was he thrashing. And just as I approached, he was being transferred from the

EMS transport gurney to our stretcher, and two staff members were standing there with leather

restraints waiting. And boom, was the sound of the patient landing on the stretcher.

He was a pretty big, strong guy,

and I could see why the police and medics had to be really aggressive with him.

...