July 2017 Critical Care Case of the Month
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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)
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
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