A 26-year-old male was acting bizarre and violent toward you and your partner. While law enforcement officers assisted you in restraining him, you note he is unexpectedly strong. His skin is hot and diaphoretic. During transport, he suddenly calms down and stops thrashing against his restraints. You should immediately:

• A. Assess his vital signs.
• B. Reevaluate his ABCs.
• C. Assess his blood glucose level.
• D. Readjust his restraints.

Answer: (B)

When a combative patient suddenly becomes calm during transport, the priority is to reassess airway, breathing, and circulation. A sudden change in status can signal respiratory or airway compromise, hypoxia, or impending cardiac arrest—especially in someone with hyperthermia and diaphoresis who may be experiencing excited delirium or severe intoxication. Quickly check if the airway is clear and patent, assess breathing adequacy (look, listen, feel for breath sounds; ensure chest rise; provide high-flow oxygen as needed), and verify circulation (pulse, skin color, capillary refill). Be prepared to intervene if the patient deteriorates, including opening the airway, delivering rescue breaths if needed, and continuing close monitoring during transport.

Vital signs are important, but they don’t address a potential airway/breathing problem. Checking blood glucose isn’t the immediate best step in this scenario, and readjusting restraints would not address a possible acute decompensation. The key idea is to keep ABCs in view and act on any signs of decline.