262.A 65-year-old man presents to the ED with a headache, drowsiness,
and confusion. He has a history of long-standing hypertension. His BP is
230/120 mm Hg,pulse 87 beats per minute, RR 18 breaths per minutes, and
oxygen saturation 97% on room air. On examination, you note papilledema.
A head CT scan is performed and there is no evidence of ischemia or hemor-
rhage. Which of the following is the most appropriate method to lower his BP?
a. Administer propofol for rapid reduction in BP.
b. Administer mannitol for rapid reduction in BP and intracranial pressure (ICP).
c. Administer a high-dose diuretic to reduce preload.
d. Administer labetalol until his BP is 140/80 mm Hg.
e. Administer labetalol until his BP is 180/100 mm Hg.
263.A 74-year-old woman is brought to the ED by EMS for altered mental
status. Her BP is 138/72 mm Hg, HR is 91 beats per minute, RR is 17 breaths
per minute, and temperature is 100.9°F. A head CT is normal. LP results
revealed the following:
274 Emergency Medicine
WBC 1020/mL with 90% polymorphonuclear cells
Glucose 21 mg/dL
Protein 225 g/LWhich of the following is the most likely diagnosis?
a. TB meningitis
b. Bacterial meningitis
c. Viral meningitis
d. Fungal meningitis
e. Encephalitis