15/12/2024
A 14-year-old adolescent boy is brought to the emergency department by ambulance after his
parents found him unresponsive in his bedroom.
Upon arrival at the home, the emergency medical services team witnessed a 5-minute generalized tonic clonic seizure for which the paramedic administered diazepam 2 mg intravenously.
The boy has a history of depression and
attention-deficit/hyperactivity disorder.
His current medications include melatonin, amitriptyline,
and dexmethylphenidate.
In the emergency department, the boy has a temperature of 38.3°C, heart rate of 188 beats/min,respiratory rate of 10 breaths/min, blood pressure of 72/45 mm Hg, and oxygen saturation of
90% in room air.
He appears sleepy, without apparent seizure activity.
His physical examination
findings are significant for dilated pupils; flushed, dry skin; and dry mucous membranes.
He has shallow breathing and decreased respiratory effort.
The remainder of his physical examination
findings are unremarkable.
The boy is intubated, and his airway is secured. Results of a complete blood count and
comprehensive metabolic panel are normal.
Shortly after intubation he is noted to have rhythm changes on the cardiac monitor; 12-lead electrocardiography is obtained and shown (Item https://drive.google.com/file/d/110lcZF0I4OYdTU3D-XWVsG-14mnoiiY6/view?usp=drivesdk
Of the following, the BEST next step in this boy’s management is to administer intravenous
A. flumazenil
B. magnesium sulfate
C. physostigmine
D. sodium bicarbonate
