A 36-year-old man is brought by ambulance to the emergency department (ED) with altered mental status and agitation. He had called one of his friend from a pay phone booth, stating that people were trying to shoot him. The friend arrived at the spot and found the patient to be visibly paranoid. His friend called an ambulance and took him to the emergency department of a nearby hospital. En route to the hospital, the patient became more confused and combative.
In ED, he was given 4 mg intramuscular midazolam but 8 people were still needed to control the patient and get him into the ED. On arrival, the patient is unable to provide much meaningful history of his present illness, but he is coherent enough to deny any previous medical problems, allergies, or prescription medication use (other than methadone). He does admit to using cocaine. Physical examination Extremely diaphoretic and…
