Abstract
A violent, psychotic patient was brought to the emergency department by the Special Weapons and Tactics (SWAT) team for medical evaluation. He was in 4-point metal police-issue handcuffs and was quite diaphoretic and hostile. Per the officers’ report, this 61-year-old man had multiple previous manic-psychotic episodes. The police had been called to his house by his neighbors after he demonstrated increasingly violent behavior. When other tactics failed to subdue him, the SWAT team shot him with 2 bean bags. The initial bean bag struck the patient on his anterior left chest wall, and the second impacted his left anterior medial thigh. He had no other obvious signs of trauma. We found it challenging, if not impossible, to interview and examine him in his aggressive state. We gave him ziprasidone (Geodon, Pfizer, New York, NY), 20 mg intramuscularly, and haloperidol (Haldol, McNeil Consumer Healthcare Company, Fort Washington, PA), 5 mg intramuscularly, to help sedate him. After 45 minutes, he was calmer, and we were finally able to care for him safely. Karen S. Schade, Member, Hawaii Chapter, Emergency Department Staff Nurse, Wilcox Memorial Hospital, Lihue, HI.
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