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A 16-year-old boy is brought to the ED by paramedics while seizing. The patient’s parents are known drug addicts and are nowhere to be found. The neighbors who called 911 claim they saw the boy seizing in the backyard and were not sure how long he had been there, but state that it took the ambulance at least 10 minutes to arrive. They are aware that the child has a long-standing seizure disorder of some kind and add that they believe he often abuses cocaine. On arrival to the ED the patient’s pulse is 125/min, blood pressure is 160/100 mm Hg, temperature is 38.9°C (102°F), and respiratory rate is 22/min. On examination the patient has his arms extended rigidly at his side and is arching his back rhythmically and appears to be aspirating blood. The patient is covered in his own urine and blood is coming from his mouth. Nasopharyngeal intubation is unsuccessful after several attempts.
Which of the following is the most appropriate next step in management?
(A) Intravenous glucose, thiamine, and naloxone
(B) Intravenous lorazepam and phenytoin
(C) Intravenous phenobarbital
(D) Placement of an electroencephalography monitor
(E) Rapid sequence intubation
 
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