Inert
Behavioral Health
0
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/Y2_F1.jpg"}},{"insert":"\n\n"},{"insert":"You\u0027re skimming through the DSM-5 before your afternoon shift at the ER, marveling at the multitude of conditions and diagnostic criteria contained within this single text, and wondering how anyone could possibly know it all offhand. \r\n\r\nYour mind wanders to a couple of rare cases that you\u0027ve managed in the past ...\n\nYou\u0027re systematically checking on your patients - a young victim of a road traffic accident; an older man who\u0027s suffered a stroke; and two children with febrile convulsions, when the clock strikes 1:00 PM, marking the beginning of your usual afternoon ER shift.\n\nYou begin managing each of them with the help of your team and before you know it, a few hours have passed.\r\n\r\nThe room begins to clear, and your next patient comes in.\n"}]}
1
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/Y2_F2.jpg"}},{"insert":"\n\n"},{"insert":"You immediately notice that he seems to need some coaxing, almost a gentle push, towards the exam room.\r\n\r\nHarrison Blunt is a 30-year-old white man with an athletic build. He is accompanied by his sister, who looks quite perplexed as she says, \u0022My brother hasn\u0027t spoken or eaten anything since yesterday!\u0022\n\nYou reassure her and request her to have a seat, and then obtain a detailed history. \r\n\r\nMr. Blunt has been suffering from schizophrenia for 15 years, for which he is currently on 5mg of haloperidol twice a day. He has no history of seizures; a recent EEG shows no epileptiform activity.\n\nYou begin to examine him and find his vitals to be stable. Although his eyes are open and he is responsive to pain, he does not react to questions or commands.\r\n\r\nYou only feel a slight resistance when you try to move his limbs. He has no command automatism or echo phenomena and a neurological exam is within normal limits.\n"}]}
2
{"ops":[{"insert":"What do you do now?\n"}]}
1. Add a second-generation antipsychotic to his treatment regimen and request him to follow-up tomorrow
2. Stop the antipsychotics, administer an anticholinergic, admit him for observation
3. Inject lorazepam intravenously and re-examine after five minutes
4
{"ops":{"insert":"\n"}}
5
{"ops":{"insert":"\n"}}
6
{"ops":{"insert":"\n"}}
3
{"ops":{"insert":"\n"}}
