A 35-year-old man with no prior psychiatric history presents to the emergency department with acute-onset disorganized speech, paranoid delusions, and agitation. Vital signs are BP 145/92 mmHg, HR 98 bpm, RR 16/min, temperature 37.2°C, and SpO2 98% on room air. Urine drug screen is negative. He is administered haloperidol 10 mg IM for behavioral control. Two hours later, nursing staff reports the patient has developed sustained leftward neck deviation, jaw clenching, involuntary upward eye rolling, and apparent distress. Neurological examination reveals no focal motor deficits, normal reflexes, and normal strength. Which of the following is the most appropriate immediate intervention?
- A)Administer additional haloperidol to increase dopamine blockade and overcome the acute extrapyramidal effect
- B)Administer lorazepam 2 mg IV to reduce muscle tension and provide sedation
- C)Administer benztropine 1-2 mg IV or IMGABARITO
- D)Initiate cooling measures and observe for spontaneous resolution within 6-12 hours
- E)Administer diphenhydramine 50 mg IM as the sole treatment for symptom relief
Explicação
Benztropine is a muscarinic antagonist (anticholinergic agent) that rapidly reverses acute dystonia caused by dopamine antagonists like haloperidol. This patient exhibits classic features of acute dystonic reaction (torticollis, oculogyric crisis, jaw rigidity... Ver explicação completa e trilha adaptativa →