Well, if by "when a patient gets difficult" you mean that they are threatening the staff with violence while spewing racial slurs it 1st depends on if you're a trauma patient. If you have a concerning mechanism, then it's RSI and a pan-scan. If you're not, then where I used to work I would've given you Geodon, but I use Haldol now since Geodon's not stocked in my new ED. I know some fans of Droperidol, but I think they might just like reading lots of ECG's. If there's no perceived threat of violence, I'll try Ativan and see how it works. I like to avoid physically restraining patients whenever possible, but you need to protect yourself, the patient, and the staff so it can sometimes be unavoidable.
But I always try verbal de-escalation first... except when you spit in someone face while we're taking care of you. Do that & even though I've never heard of it before -you're getting "quoned".