Struggling today...

Am struggling today. My 5-year-old is out of control this morning...spitting, kicking, pinching, headbutting, hurting his sisters left and right, whatever he can do to push their buttons, when I would send him to time out he would refuse to go and so I'd sit with him on my lap and he'd headbutt me, twist around and spit in my face, squeeze his eyes shut so he wouldn't look at me and laugh hysterically. Took my older daughters wrist that was already sprained and grabbed it and bent it backwards and she's been crying that it hurts even more. I called the psychiatrist's office and told them that his appt isn't until Wedensday and I don't know what to do with him. The receptionist wanted me to bring him in to the children's hospital (45 min away) ER and have him seen by the psych on call. Got all the way down there and a huge storm hit with hail and rain, the baby was super fussy as she's just getting over a double ear infection, and I wasn't getting out and getting everyone sopping wet. And my 5-year old had been calm the whole way there and I didn't know what they'd say if I said he'd been out of control. I feel paralized with not knowing what to do. Now we're home and I sent him to his room, he won't stay in there and when I direct him back there he just laughs and comes out again.