“Unresponsive”

Chief Complaint

  • 37 year old male was brought into the ED by family after being found down in his home

HPI

  • Has a pulse, breathing on his own, but was unresponsive, so intubated in the ED for airway protection
  • Per family, last known normal was this morning
  • Unknown if recently used drugs or alcohol

PMH

  • Methamphetamine Use
  • Alcohol Use Disorder
  • Major Depression Disorder
  • Type II Diabetes

Family History

  • Non-contributory

Social History

  • Never smoker
  • History of methamphetamine use
  • Alcohol use disorder

Vitals

Temp: 37.1° C, BP: 112/64 mmHg, HR: 110 bpm, SpO2: 95% on ventilator

Ventilator Settings: Volume Control, VT 320, FiO2 0.30, PEEP 8, RR 22

Physical Exam

  • Intubated and ventilated
  • Remains unresponsive when sedation is weaned

Lab

  • WBC 10.2, Hgb 12.4, Plt 245K
  • Na+ 140, K+ 4.2, Cl 105, HCO3 14, BUN 14, Cr 0.8, Glucose 88
  • AST: 37, ALT 25, Total Bilirubin 0.3, Albumin 3.5
  • ABG: pH 6.88, PaCO2 31 mmHg, PaO2 94 mmHg
  • Serum Osmolality: 305

Imaging

  • CT head without contrast does not show any significant findings

What’s on your differential diagnosis?

What would you do next in the work-up for this patient?

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