The Hostile-Combative Patient

Case Synopsis

A 14-year-old boy with an established diagnosis of autistic spectrum disorder is scheduled for a semielective release of hand contracture that he suffered as a sequela to a burn injury at age 5. He has had three prior surgeries and is known to have difficult emergence. Currently he is in the holding area obsessively playing a computer game on his tablet and ignoring requests to go to the operating room. His parents are distressed and apprehensive about the situation and frequently question the staff’s ability to address the situation in an adequate manner.