Those of us that work in the emergency department unfortunately have grown used to dealing with the unruly intoxicated patient. Whether it's due to drugs, alcohol, or a lovely combination of both, we know the look as soon as they walk in the door. They didn't ask to be brought in here, but either the police, a family member, or a concerned citizen deemed it necessary that they be plucked from their natural habitat and brought to the hospital.
They do not wish to be here, but now that they are, the responsibility falls on healthcare professionals to keep them safely within our doors until they have the functional capacity to be let loose back into the "real world"
Under the influence, people become unreasonable. They resort to verbal and physical aggression. They yell, kick, scream, bite, spit, and run. And we must stop them from harming themselves or us. And I do not have the patience.
My rule is that I will give a patient 2-3 attempts at verbal redirection before I call the doctor, requesting medications and restraints.
Other nurses try over and over to reason with them, redirect them to calmly sit on their stretchers, and five minutes later they're up and hollering again. Not happening. It takes too much of my time, as well as the techs, security and doctors. The other "normal" patients are watching and hearing the ruckus and enough is enough. They get restrained. They get an IM injection. They fall asleep. The restraints come off, and when they wake up calm anc cooperative in a few hours they can go home.
Yesterday I was in the process of calling the doctor to get orders to put my patient down when another nurse walks over. "Well let me just talk to them first. I know how to talk to these people. I know how to settle them down." No. These are not rational humans in the frame of mind to reason with you. This is my patient, we've attempted to calm him down, and that's it. I refuse to play these games.
On the other hand, I'm not heartless. If a patient comes in with a psychiatric disorder, I don't jump as quickly to sedate them. They are more reasonable, and can usually be calmed if you set boundaries, and reward with TV privileges or extra juice boxes.
So that's my two cents. Let this be a lesson to all you in these coming summer months. If you come to my ER and you're AFU and causing a scene, you're getting tied down and a big needle in your thigh. Then its sleepy time.
TL;DR: If you're coming to me because you're drunk and unruly, remember that I get to pick your needle size.
-K
