A confused 30-year-old male with flushed dry skin and fever after taking 500 mg diphenhydramine; pupils dilated; glucose 73 mg/dL. What should you do?

• A. Rapidly cool him.
• B. Transport him.
• C. Administer oral glucose.
• D. Administer oxygen.

Answer: (B)

This is anticholinergic toxicity from diphenhydramine overdose. The signs—hot, dry skin with flushing, dilated pupils, and confusion—fit the toxidrome caused by anticholinergic agents. The immediate aim in the field is to get the patient to a setting where close monitoring and definitive care can be provided, including IV access, careful fluid management, cooling for hyperthermia, and potential antidotal therapy under supervision. Oral glucose isn’t indicated because his glucose is 73 mg/dL, not hypoglycemic. Oxygen is only necessary if he develops hypoxia. While cooling can be started, stopping the on-scene management at transport is not appropriate; rapid transport to the emergency department for continuous monitoring and treatment is the best next step.