48-year-old with Altered Mental Status and Respiratory Failure: A Case Report

Introduction: The differential diagnosis for altered mental status and respiratory failure is broad. Careful physical examination, appropriate use of diagnostic tools, and accurate interpretation and correlation of test results are important for piecing together the puzzle of a patient with altered...

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Autores principales:	Justin E. Pile, Justina Truong
Formato:	article
Lenguaje:	EN
Publicado:	eScholarship Publishing, University of California 2021
Materias:	Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/f0751677e53b4b52b194ab40c8657e2a
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spelling	oai:doaj.org-article:f0751677e53b4b52b194ab40c8657e2a2021-11-23T20:02:52Z48-year-old with Altered Mental Status and Respiratory Failure: A Case Report2474-252X10.5811/cpcem.2021.3.51331https://doaj.org/article/f0751677e53b4b52b194ab40c8657e2a2021-11-01T00:00:00Zhttps://escholarship.org/uc/item/2n0194qxhttps://doaj.org/toc/2474-252XIntroduction: The differential diagnosis for altered mental status and respiratory failure is broad. Careful physical examination, appropriate use of diagnostic tools, and accurate interpretation and correlation of test results are important for piecing together the puzzle of a patient with altered mental status that emergency physicians commonly face. In certain cases, such as this one, rapid diagnosis and management is crucial for improving patient morbidity and mortality. Case Presentation: A 48-year-old male with altered mental status and respiratory failure presented to the emergency department after being found unconscious on his porch. Vital signs were notable for temperature 105.5 °F, blood pressure 202/102 millimeters of mercury, pulse 126 beats per minute, respiratory rate 30 breaths per minute, and oxygen saturation 91% on room air. Physical examination revealed an obese male lying in bed awake in severe distress with labored breathing and unable to converse. His physical examination was significant for dry mucous membranes, tachycardia, and bilateral lower extremity 1+ pitting edema. He also appeared to have Kussmaul respirations with severe tachypnea, but his breath sounds were clear to auscultation bilaterally. On further examination, the patient appeared to have intravenous (IV) injection markings along his arms suggesting the possibility of IV drug use. Discussion: With limited history, the only context clues initially available to assist in the diagnosis were abnormal vital signs and physical examination. The patient was tachycardic, hyperthermic, hypertensive, hypoxic, and tachypneic with altered mental status; he eventually required endotracheal intubation for hypoxic respiratory failure. The complexity of his condition prompted a large list for the differential diagnoses. Toxidromes, endocrine abnormalities, infectious process, cardiac and/or renal etiologies, and neurological pathology such as a cerebrovascular accident were considered. In the case of this patient, urgent diagnosis and management was crucial to prevent further decompensation and improve his outcome.Justin E. PileJustina TruongeScholarship Publishing, University of CaliforniaarticleMedical emergencies. Critical care. Intensive care. First aidRC86-88.9ENClinical Practice and Cases in Emergency Medicine, Vol 5, Iss 4 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Justin E. Pile Justina Truong 48-year-old with Altered Mental Status and Respiratory Failure: A Case Report
description	Introduction: The differential diagnosis for altered mental status and respiratory failure is broad. Careful physical examination, appropriate use of diagnostic tools, and accurate interpretation and correlation of test results are important for piecing together the puzzle of a patient with altered mental status that emergency physicians commonly face. In certain cases, such as this one, rapid diagnosis and management is crucial for improving patient morbidity and mortality. Case Presentation: A 48-year-old male with altered mental status and respiratory failure presented to the emergency department after being found unconscious on his porch. Vital signs were notable for temperature 105.5 °F, blood pressure 202/102 millimeters of mercury, pulse 126 beats per minute, respiratory rate 30 breaths per minute, and oxygen saturation 91% on room air. Physical examination revealed an obese male lying in bed awake in severe distress with labored breathing and unable to converse. His physical examination was significant for dry mucous membranes, tachycardia, and bilateral lower extremity 1+ pitting edema. He also appeared to have Kussmaul respirations with severe tachypnea, but his breath sounds were clear to auscultation bilaterally. On further examination, the patient appeared to have intravenous (IV) injection markings along his arms suggesting the possibility of IV drug use. Discussion: With limited history, the only context clues initially available to assist in the diagnosis were abnormal vital signs and physical examination. The patient was tachycardic, hyperthermic, hypertensive, hypoxic, and tachypneic with altered mental status; he eventually required endotracheal intubation for hypoxic respiratory failure. The complexity of his condition prompted a large list for the differential diagnoses. Toxidromes, endocrine abnormalities, infectious process, cardiac and/or renal etiologies, and neurological pathology such as a cerebrovascular accident were considered. In the case of this patient, urgent diagnosis and management was crucial to prevent further decompensation and improve his outcome.
format	article
author	Justin E. Pile Justina Truong
author_facet	Justin E. Pile Justina Truong
author_sort	Justin E. Pile
title	48-year-old with Altered Mental Status and Respiratory Failure: A Case Report
title_short	48-year-old with Altered Mental Status and Respiratory Failure: A Case Report
title_full	48-year-old with Altered Mental Status and Respiratory Failure: A Case Report
title_fullStr	48-year-old with Altered Mental Status and Respiratory Failure: A Case Report
title_full_unstemmed	48-year-old with Altered Mental Status and Respiratory Failure: A Case Report
title_sort	48-year-old with altered mental status and respiratory failure: a case report
publisher	eScholarship Publishing, University of California
publishDate	2021
url	https://doaj.org/article/f0751677e53b4b52b194ab40c8657e2a
work_keys_str_mv	AT justinepile 48yearoldwithalteredmentalstatusandrespiratoryfailureacasereport AT justinatruong 48yearoldwithalteredmentalstatusandrespiratoryfailureacasereport
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48-year-old with Altered Mental Status and Respiratory Failure: A Case Report

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