What is the Diagnosis?

Question

A 38 years old male is brought to Emergency Department(ED). The patient's was found living near the sloop of an apartment building. The paramedics were unable to obtain only history from the patient en route because the patient has an Altered mental status.

On arrival the patients VS are on oral temperature of 35.4C, Blood pressure of 88/40, heart rate of 38 beats per minute. Result of his cardiac examination are significant for marked bradycardia. A lung examination reveal rhonchi in the right lower lung field. The patients is cold and his blood glucose level is 104mg/dL.

Answer 1

He is altered and unable to provide any history. From your description of where he lives, it sounds like he might be homeless.

Homelessness can make diagnosing an acute medical issue a bit trickier, because more than likely, he hasn't gotten any medical care for quite some time. He might have a medley of yet to be diagnosed illnesses, many of which might be contributing to his current issue.

Substance abuse is always a possibility. There's a lot of information that you left out. What is his respiratory rate? What are his pupils like? If they are constricted, you might consider a narcotics OD and give Narcan. There are a lot of possibilities; he might have overdosed on a benzodiazepine. If a benzodiazepine is suspected, Flumazenil would be the appropriate drug. What about signs of trauma? An intracranial hemorrhage might be suspected. He doesn't seem to have all the usual symptoms, though.
Have you considered congestive heart failure? Does he have any peripheral edema?

That's about all the thinking I'm ready to do this evening. Hope this gives you a few things to consider.

Answer 2

Sounds like a substance abuse overdose.

Answer 3

Patient overdosed on xanax or some other drug.

Answer 4

Do your own work.