Question

A 46 year old homeless man is brought to the hospital after passersby witnessed him having convulsions on the street. On physical examination, the patient is disheveled, unshaven, and has a faint odor of alcohol on his breath. He is semicomatose, and arouses only to pain. Vital signs are temperature 38.3 C (101 F), pulse 115, blood pressure 166/96, respirations 15/min, and oxygen saturation 98% on room air. There is a 4cm simple laceration on his left temple. There are no other visible injuries, and the remainder of the physical examination is normal. Laboratory evaluation shows the following: Hematocrit 38%; mean corpuscular volume 109 fL; sodium 133 mEq/L; glucose 62 mg/dL; magnesium 1.0 mEq/L; albumin 3.0 g/dL; ALT 60 IU/L; AST 123 IU/L; PT 19 s. The patient is placed in mechanical restraints and i.v. fluid with glucose, thiamine, folate, and magnesium is begun. Which of the following is the most appropriate next step in the management of this patient?

A. IV diazepam
B. Oral phenobarbital
C. MRI of head/neck
D. LP
E. IV somatostatin

Answer 1

The most appropriate next step is IV diazepam to treat the patient's seizures.

Step-by-step explanation:

The most appropriate next step in the management of this patient is A. IV diazepam, which is used to treat seizures. Given that the patient had convulsions, it is important to address the immediate seizure activity. The other options, such as oral phenobarbital, MRI of head/neck, LP, and IV somatostatin, are not the most appropriate next steps in managing seizures.