You are working in a busy emergency department on a very hot day in the summer. A 16-year old boy is brought in by 2 friends who state that they were outside hiking on a nearby mountain range all day. The friends report that the patient began to complain of nausea and "seeing bright lights," after which he became increasingly confused and disoriented. They were able to get him to a vehicle and bring him to the hospital, but during the 15-minute car ride he vomited and then lost consciousness briefly. They are not aware of any medical problems that the patient may have. Glancing at his chart, you see that his temperature was recorded as 39.5 C (103.1 F), blood pressure 110/68 mm Hg, pulse 122/min, and respirations 20/min. You walk over to examine him and note that he is sitting upright in the gurney talking rapidly and incoherently in a loud voice. He does not answer your questions. You quickly perform an initial examination and find that his skin is erythematous and warm to touch, but he does not appear to have a rash. Except for slightly dry mucous membranes and tachycardia, the examination is otherwise normal. During your examination, he seems to become somewhat calmer and is able to cooperate with a brief neurologic survey which is non-focal. While you are examining the patient, the nurse draws blood and you send it for the appropriate laboratory studies. The most important immediate next step in the management of this patient is to
A. administer acetaminophen
B. begin empiric antibiotic therapy
C. call the patient's parents to obtain his medical history
D. initiate cooling measures
E. perform lumbar puncture and blood cultures
F. obtain urine for drug screen
G. order a CT scan of the head
|