A 45-Year-Old Man Arrives at the Emergency Room with Several

A 45-year-old man arrives at the emergency room with several hand lacerations from punching his hand through a glass. When the patient returned home from work to find his wife had walked out and taken their two children, he claims he "momentarily lost control." The temperature is 37.2 ° Celsius (99 F) , the blood pressure is 150/88 mm Hg, and the pulse rate is 96 bpm. The patient's right hand has many abrasions and cuts, and he is advised that two lacerations will require suturing. "I've been waiting a terribly long time and have to get out of here and put things right with my wife and kids," the patient adds furiously. I no longer have time for stitching. 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?