Your patient is a 42-year-old male who is supine on the floor, responsive only to pain. His wife states that he has been extremely depressed recently and talked about suicide yesterday. The patient's skin is hot and dry, pupils are dilated and reactive to light bilaterally, and there is vomit around his mouth. HR = 138 and regular, BP = 82/52, RR = 16 and shallow. Temperature is 105.5°F. The patient has a history of hypothyroidism, for which he takes Synthroid. Your partner suctions the airway and initiates BVM ventilations with 100 percent oxygen and an oropharyngeal airway. In addition to monitoring the cardiac rhythm and starting an IV of normal saline, you should:

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The patient's presentation is consistent with a drug overdose, likely an intentional overdose due to his history of depression and suicidal thoughts. The elevated temperature and dilated pupils suggest anticholinergic toxicity. Intubation is indicated to protect the airway and provide mechanical ventilation. Propranolol is a beta-blocker and is not indicated in this scenario. Diltiazem is a calcium channel blocker and also not indicated. Dextrose is indicated for hypoglycemia, which is not suspected in this case. Synchronized cardioversion is not indicated as the patient is in a stable rhythm.

Your Patient Is a 42-Year-Old Male Who Is Supine on the Floor