Case 2

A 48-year-old woman is brought into the department by the ambulance service.

She had had a drink or two. She became rowdy and then passed out for a short time while at a party. She then recovered.

On arrival at hospital, she makes racist comments towards a member of staff and tells you that she wants to see a ‘real’ doctor.

She seems to be slightly inebriated and has no signs of injury.

Her observations are pulse 120, BP 127/73, respiratory rate 15, temperature 37.2, GCS 14, Pupils size 5 and equally reactive to light.

She does not consent to a blood sugar assessment.

She reports no previous medical problems.

After waiting for less than ten minutes, she is seen walking from cubicle to cubicle offering very personal and offensive comments to staff and patients.

Consider how you could best handle this situation

What underlying condition is most likely to be the cause of her behaviour?

List eight common causes of disturbed and violent behaviour in the ED.

The patient becomes more disturbed and you are unable to assess her. She will not allow you to do any further observations, and pulls away or hits out when you try to do a blood glucose. She refuses a drink of water. You decide that rapid tranquilisation is required. Choose the appropriate prescription