In the ED, he is violently bucking restraints, threatening to kill everyone who touches him. His general exam shows a diaphoretic man pulling at his four-point restraints and rocking the gurney back-and-forth. There is no obvious trauma, deformity, source of infection. On questioning he is inattentive and tangential. He does not answer any of your questions.
HR 168 BP 190/100 RR 30; temperature and oxygen saturation measurements are not feasible at this point.
Regarding this patient’s presentation, what is the BEST answer:
A. A thorough medication history is needed to evaluate dangerous etiologies such as serotonin syndrome
B. Treat him acutely for likely withdrawal from his psychotropic medications for schizophrenia
C. After sedation, obtain a stat echocardiogram
D. Avoid a prone position for the patient during initial restraint
In the meantime, a quote –
“Well, now, there’s a remedy for everything except death.”
-- Miguel de Cervantes (1547-1616)