Welcome to the Emergency Medicine Cases podcast with your host, Dr. Anton Hellman, bringing you Canada's brightest minds in emergency medicine from EMC Studios in Toronto.

There are few things you can hear overhead that get my blood pumping quite so much as those four

little words, code white emergency department. There's a special place in the emergency doc's brain for the

agitated patient, and that place is located right between the panic and poise centers. Hey, I never said I was a neurologist.

The reason these patients may evoke a particularly visceral response are many. They're complex.

They can be psychiatric patients or they can be medical patients or they can be trauma patients

or all the above. They can be old or young, frail or physically imposing.

And to make things all the more critical, they are themselves in danger and they endanger

your team.

So to help ease your discomfort, today we have two familiar voices to Ian cases, Dr. Ruben

Strayer, well-known educator and creator of EM updates from

New York, and Dr. Margaret Thompson, medical director of the Ontario Poison Control Center,

who are going to show us exactly how much more there is to the agitated patient than the old

five and two of haloperidol and lorazepam.

Let's jump into our first case.

You're working a relatively quiet night shift in your small suburban ED when you hear a man loudly yelling a series of profanities from the triage area.

You go out to triage and see a man who looks to be about 20 years old, stumbling around with a ripped bloody stained t-shirt.

He looks sweaty and flushed.

The triage nurse tells you that he was dropped off in the ambulance bay by a bunch

of guys in a sports car who immediately took off. You keep your distance and calmly ask,

how can I help you, sir? The man starts to lunge towards you and yells, you're dead. At which time,

two security guards grab his arms. He spits in the face of one of them.

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