A 45-Year-Old Man Comes to the Emergency Department with Multiple

question 128

Multiple Choice

A 45-year-old man comes to the emergency department with multiple hand lacerations sustained when he punched his hand through a window.  The patient says he "momentarily lost control" when he came home from work to find that his wife had moved out of the home and taken their two children.  Temperature is 37.2 C (99 F) , blood pressure is 150/88 mm Hg, and pulse is 96/min.  The patient has multiple abrasions and cuts on his right hand and is informed that two lacerations will require suturing.  The patient is agitated and angrily says, "I've been waiting a really long time and have to get out of here and set things straight with my wife and kids.  I don't have time for stitches anymore.  You are all incompetent."  Which of the following questions is most appropriate in determining the best next step in management of this patient?

• A)Have you been drinking alcohol or using any illicit drugs?
• B)Have you been thinking about hurting yourself or someone else?
• C)I understand you are in a rush, but do you understand that suturing your wounds is top priority?
• D)What are your plans for getting treatment of your hand injury if you decide to leave now?
• E)You seem upset.  Are you feeling angry about your wife leaving you?

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