A 30-Year-Old Man Is Brought to the Emergency Department by an Ambulance

A 30-year-old man is brought to the emergency department by an ambulance after a gas station attendant noticed the patient disoriented and wandering aimlessly.  The patient has had nausea, vomiting, and dizziness.  Emergency department records indicate that the patient has a history of schizophrenia, but he cannot remember the names of his medications.  He also has limited memory of the previous day.  The patient smokes cigarettes occasionally and does not use alcohol or illicit drugs.  Temperature is 41.1 C (106 F), blood pressure is 90/60 mm Hg, pulse is 128/min, and respirations are 26/min.  The patient is lethargic and appears disheveled and sunburned; he is oriented to person only.  The skin and oral mucous membranes are dry.  The lungs are clear to auscultation.  The heart rhythm is regular with no murmurs.  Muscle tone is moderately decreased and reflexes are normal.  He moves all extremities to command.  Laboratory results are as follows: Urine drug screen is positive for methamphetamines.  Chest x-ray is clear.  CT scan of the head without contrast shows no acute intracranial abnormalities.  Which of the following is the most appropriate immediate step in management of this patient?

A)Antipyretics
B)Broad-spectrum antibiotics
C)Dantrolene
D)Evaporative and convective cooling
E)Intravenous lorazepam

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