Case: De-escalate before you sedate

Candidate brief (2 minutes reading)

You are the paediatric consultant on. A 15-year-old is brought to the emergency department by ambulance after an unknown ingestion at a party. He is severely agitated, has struck a paramedic, and is screaming that he is being chased. Observations: temperature 39.0 degrees Celsius, heart rate 155, blood pressure 175 over 105, respiratory rate 28, SpO2 96 percent in room air. He has mydriasis, diaphoresis, inducible clonus and hyperreflexia. Behavioural Activity Rating Scale 7. Bedside glucose 5.8 millimoles per litre. The cubicle is crowded with ambulance crew, security and onlookers. His parents have not yet arrived.

You have a registrar, a senior nurse, a junior doctor, an enrolled nurse, and a security officer available.