Answer targeted questions : PSY-Q

Question : 1 / 258

A 29 year-old-man has been admitted after sustaining an open tibial fracture in a rugby match. He is diaphoretic and angry about being rushed through the ED for admission onto the general hospital floor without letting him check on who might have his car. His girlfriend says he stopped using cocaine last year. The current heart rate is 119 BPM per the pulse oximeter he just ripped off before it showed a 100% reading on room air. There are no other vital signs available, no lab results have come back, an EKG has not been completed, and there is no IV in place. What medication will you deliver IM to provide for calm, and why?

Lorazepam 2mg, because it is not clear what is going on yet, but the history of cocaine use and pieces of physical exam suggest a stimulant could be responsible, and seizure or arrhythmia is a concern
Haloperidol 10 mg, because excessive drinking is fairly common in rugby players, and first-generation antipsychotics are the treatment of choice for agitation secondary to alcohol intoxication
Ketamine 250 mg, because it works faster than any other agent available to manage agitation, and the patient has an acute pain condition that may also benefit from this medication
Olanzapine 10 mg, because it has multiple mechanisms of action that can provide the results desired -- dopamine blockade for aggression, serotonin antagonism to stabilize affective lability, and histaminic/muscarinic antagonism to produce sedation

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