“Agitation”

A 22 year-old Caucasian male is brought in by police after being found running in the middle of
the road naked, yelling obscenities at passing cars. Officers were forced to deploy tasers to
restrain the patient, who is now handcuffed to a hospital gurney, screaming and straining against
his restraints. The patient is hot to the touch, with myoclonic jerking and bruxism. He is
unkempt, with long hair and a full beard, and ruddy, sunburned complexion. The patient doesn’t
sit still long enough to allow a blood pressure. Pulse is 144, with SpO2 of 97% on room air. Five-
lead EKG shows his QTc at 508ms. His BMI is 17.0 kg/m2. Most of his words are unintelligible,
but he makes momentary eye contact with you and yells, “I am God and I am the Devil, and the
reckoning is upon you! You will pay for their sins.”

What is your next step in management of this patient?

a. Metoprolol, 15mg IV
b. Haloperidol, 10mg IM
c. Lorazepam, 2mg IM
d. Prazosin, 2mg IV

a. Incorrect. Excited delirium could be attributed to unknown drug intoxication.

Administering a beta blocker can result in unopposed alpha stimulation, and uncontrolled
tachycardia and hypertension.
b. Incorrect. Haloperidol runs the risk of prolonging the patient’s already lengthened QT,
putting him at risk for Torsades de Pointes.
c. Correct. Benzodiazepines are an acceptable choice in the treatment of excited delirium
d. Incorrect. While prazosin could work in hypertension, the patient’s blood pressure is
unknown, and a psychotropic medication would be more appropriate.