July 2017 Critical Care Case of the Month

Robert A. Raschke, MD

Banner University Medical Center Phoenix

Phoenix, AZ USA

History of Present Illness

A 62-year-old man was brought to the Emergency Department with an altered mental status after a neighbor found him unresponsive. Medications the paramedics found in his home were cyclobenzaprine, duloxetine, gabapentin, levothyroxine, ibuprofen, and tramadol.

Past Medical History, Social History and Family History

He had a past medical history of neck and back pain and hypothyroidism. He lived alone. There was a history of a C3-4 anterior cervical discectomy in 2010. Other history including family history was unobtainable.

Physical Examination

• Vital Signs: HR 61 beats/min, BP 86/50 mm Hg, RR 8 breaths/min, T 32.2º C
• General: arousable but did not answer questions. He had multiple tattoos. No needle track marks are identified.
• HEENT: pupils were small but reacted to light.
• Lungs: clear to auscultation.
• Heart: regular rhythm without murmur.
• Abdomen: soft without organomegaly or masses.
• Neurology: he moved all 4 extremities but minimally. Plantar reflexes were downgoing.

Which of the following should be done immediately? (Click on the correct answer to proceed to the second of six pages)

1. Administer naloxone
2. CT scan of the head
3. Obtain a blood glucose
4. 1 and 3
5. All of the above

Cite as: Raschke RA. July 2017 critical care case of the month. Southwest J Pulm Crit Care. 2017;15(1):7-14. doi: https://doi.org/10.13175/swjpcc081-17 PDF