A 46-Year-Old Man Is Brought from Jail to the Emergency

A 46-year-old man is brought from jail to the emergency department after a suicide attempt.  The patient was arrested earlier today for possession of drugs and shortly afterward was found trying to strangle himself with a shoelace.  He was unconscious for a few seconds until the shoelace was cut from his neck.  On arrival, the patient is alert and fully oriented.  Vital signs are within normal limits.  Physical examination shows ligature marks on the neck but is otherwise normal.  Urine drug screening is positive for cocaine and opiates.  CT scan of the head and neck reveals no abnormalities.  The patient is admitted for psychiatric treatment.  A few hours later, he becomes restless and anxious and reports feeling nauseous.  Temperature is 37.7 C (99.9 F) , blood pressure is 138/90 mm Hg, and pulse is 100/min.  The patient appears flushed and diaphoretic.  Heart and lung sounds are normal.  Physical examination shows no other abnormalities.  ECG demonstrates sinus tachycardia.  Complete blood count and comprehensive metabolic panel are normal.  Which of the following is the most appropriate next step in management of this patient?

A) Administer metoprolol
B) Obtain blood cultures
C) Order a chest x-ray
D) Prescribe clonidine
E) Start naltrexone

Correct Answer:

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