Thanks, everyone for your replies. Perhaps some more information would clarify things, although I do enjoy the discussion:
The problem is that I was moonlighting at a community hospital whose inpatient psych unit doesn't accept involuntary patients. Insured + voluntary only. She was clearly involuntary. As part of the moonlighting deal I see floor and ED consults as well as manage the inpatient unit.
I was going to have to transfer her somewhere else that did accept involuntary patients. In order for me to get the recieving hospital (called a Level 1 hospital in that state) to accept her I was afriad I'd have to get some labs. Would you accept a floridly psychotic patient with a h/o complicated withdrawal (e.g., serious DT's), and pancreatitis in transfer without labs? I wouldn't and don't!
Thus, without the labs I was concerned that the patient was going to sit in the community hospital ER until she got better. Even after 20mg Geodon IM x2 + Ativan she wasn't willing to give vitals or labs. She was extremely psychotic. She certainly didn't have capacity to refuse labs if it were a question of delirium. But is it worth restraining her for? I don't know. The breathylzer is a good idea - less invasive and she'd be more likely to accept.
So to summarize I saw myself as having two options:
1) Keep her in the ED until something changed (she agreed to get labs or got better) - which could be >24hrs
2) Restrain her to get the labs to facilitate the transfer
Which one would you pick? Is there a third option?
I'm putting this out there, and really enjoying everyone's advice, because I'm nearing the end of my residency and I feel as though I should have complete mastery over this situation by now. I've had plenty of ED docs restrain psych patients to get labs - but I've never been the one myself to do so. Of course, I'm just a consultant, but I feel like I should know the answer to this.
Last edited by BobA; 04-07-2012 at 07:24 PM.