IMO any time you are having thoughts of being violent and there is any chance whatsoever you are going to act on them you should go to the ER and you should be admitted to the hospital. I have random thoughts of suicide--like drive by a bridge and immediately have a mental image of jumping or cutting up veggies or fruit and having a sudden thought of cutting my wrists or stabbing myself. Because I know I won't act on them I don't worry about it. If I was having thoughts of hurting other people I would call mobile crisis or my psych and ask to be admitted to the hospital. Better safe than sorry.