A 34-year-old man is brought to the emergency department by paramedics after being found confused and severely agitated in his apartment. Beside him are empty bottles of tranylcypromine and fluoxetine. In the emergency department, he is delirious and thrashing violently. His temperature is 39.5°C (103.1°F), blood pressure is 170/105 mm Hg, and pulse is 135/min. Physical examination reveals pronounced diaphoresis, hyperreflexia, and sustained ankle clonus bilaterally. Shortly after the initial assessment, the patient develops a generalized tonic-clonic seizure.
The patient's electronic health record contains a legally executed medical power of attorney designating his long-term partner as his sole healthcare proxy. The partner is currently on an international flight and cannot be reached. The patient's biological parents, who were notified of the emergency by the landlord, arrive at the hospital. They declare themselves as his legal next-of-kin and demand that all medications be withheld, insisting he 'just needs to sleep it off without chemical interference.'
Which of the following is the most appropriate next step in management?
- Administer intravenous lorazepam immediately under the doctrine of implied consentCevap
- BWithhold pharmacological intervention to comply with the demands of the biological parents present at the bedside
- CDelay administration of medications and apply four-point physical restraints until the designated healthcare proxy can be reached
- DAdminister intravenous haloperidol to urgently control the seizures and delirium while awaiting proxy contact
- EDisclose the specific details of the patient's psychiatric diagnoses and advance directives to the parents to mediate a consensus on treatment