A 32-Year-Old Man Is Brought to the Emergency Department After

question 140

Multiple Choice

A 32-year-old man is brought to the emergency department after falling from a fourth-floor balcony of his apartment building.  A witness at the scene reported that the patient stood on the balcony ledge for several minutes beforehand, looking down toward the street.  His fall was broken by a tree, and he sustained multiple minor injuries, including abrasions and lacerations to his face and the extremities.  The patient explains that he had a couple of beers and lost his balance while he was birdwatching.  He has no medical history but reports that he has lost some weight and feels tired because he cannot sleep due to the loud street noise in his neighborhood.  He lives alone and is worried about not being able to pay the rent if he does not find work soon.  The patient drinks 3 beers on most weekdays and 4 or 5 beers on weekends but does not use illicit drugs.  His vital signs, complete blood count, and comprehensive metabolic panel are within normal limits.  Blood alcohol concentration is 0.005%.  The patient's lacerations are sutured, and he is medically cleared.  Mental status examination shows a thin, anxious man who is cooperative and oriented to person, place, and time.  The patient makes poor eye contact and gives brief responses, repeatedly insisting, "Everything's fine, I'm okay.  I just want to go home."  He says he is not suicidal.  Which of the following is the most appropriate next step in management of this patient?

• A)Arrange outpatient psychiatric follow-up for the following day
• B)Discuss options for antidepressant therapy and recommend outpatient psychotherapy
• C)Hospitalize the patient involuntarily
• D)Observe the patient in the emergency department for 24 hours and then reassess
• E)Perform a brief intervention for alcohol use
• F)Refer the patient to social services

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Definitions:

Consistent Definition

A definition that remains uniform or unchanged across different contexts or uses.

Historical Problem

An issue or challenge that exists or has evolved due to the influence of past events or practices.

Initial Disclosure

The first time a person reveals or reports an incident, often referring to moments of abuse or trauma.

Counselors

Professionals trained to offer guidance on personal, social, or psychological problems, providing support and advising individuals or groups.