A 42-year-old man was admitted to the hospital with pneumonia. On the third day of his hospitalization he becomes agitated and confused. He reports feeling “spiders” crawling on his skin. You note that he has a blood pressure of 172/94 mm Hg, heart rate of 107/minute, and temperature of 38°C (100.4°F). With the exception of agitation and tremor, the remainder of his physical examination is unchanged from earlier in the day. What is the best initial step in management of this patient?
A. Emergent non-contrast CT scan of the brainThis patient exhibits several symptoms suggestive of acute alcoholic withdrawal syndrome, including hypertension, tachycardia, fever, and delirium. An acute intracranial event will usually be associated with head trauma (subdural hematoma) or focal neurological abnormalities. In addition, radiographic imaging may be difficult to perform while the patient is acutely agitated. Haloperidol is commonly used to treat acute psychosis, but benzodiazepines are better in the setting of alcohol withdrawal. The patient’s blood pressure will likely improve with administration of benzodiazepine and beta-blockade may be unnecessary. Physical restraints should only be used as a therapy “of last resort” and do not take the place of treating the underlying disorder.