A 38-year-old man is brought to the ED by police for erratic behavior from the downtown area.  The man was found screaming at patrons of a local restaurant that he would “cut out their eyes”, then ran out and began thrashing in the bushes.  The police called for back-up, and 6 officers were eventually able to restrain him.

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.”

Don Quixote

-- Miguel de Cervantes (1547-1616)