Combative delirium.

摘要

I was recently in the compromising position of "wrestling" with an out-of-control hospice patient, who was a 51-year-old man with metastatic adenocarcinoma of the pancreas and had been admitted to an inpatient facility the previous day. Three nurses, struggling to keep this large man in his bed, asked for help while I was making an evening courtesy visit; I was the only physician on site at the time. The patient was in the throes of delirium that manifested as a combative stance. Adding stress to the situation was the patient's sister, who was standing in the background and quietly observing our activity. It has been 20 years since I worked in the emergency department, and even longer since I entered a psychiatric facility. To say that I felt unprepared is an understatement.