April 2019 Critical Care Case of the Month: A Severe Drinking Problem

Francisco J. Marquez II MD

Department of Pulmonary and Critical Care Medicine

Banner University Medical Center/University of Arizona – Phoenix

Phoenix, AZ USA

History of Present Illness

A 55-year-old Caucasian man, presented to an outside hospital with altered mental status.

Past Medical/Social History

• Severe alcohol and intermittent fentanyl abuse
• Homelessness

Physical Exam

• Hypothermic and hypertensive.
• Patient encephalopathic without any acute deficits
• Pupils are normal sized and react to light

Which of the following should be obtained or done in his initial evaluation? (Click on the correct answer to proceed to the second of six pages)

1. CBC
2. Electrolytes
3. Give naloxone (Narcan®) and glucose
4. 1 and 3
5. All of the above

Cite as: Marquez FJ II. April 2019 critical care case of the month: A severe drinking problem. Southwest J Pulm Crit Care. 2019;18(4):67-73. doi: https://doi.org/10.13175/swjpcc003-19 PDF 

October 2018 Critical Care Case of the Month: A Pain in the Neck

Robert A. Raschke, MD

Critical Care Medicine

HonorHealth Scottsdale Osborn Medical Center

Scottsdale, AZ USA

History of Present Illness

A 54-year-old man was admitted after he had a decline in mental status. He complained of neck and back pain for one week prior to admission for which he took acetaminophen. He was seen in the emergency department two days prior to admission and diagnosed with “arthritis” and prescribed oxycodone/acetaminophen and cyclobenzaprine. On the day of admission be became unresponsive and was transported by ambulance to the emergency department where he was intubated for airway protection.

Past Medical History, Social History, Family History

• Alcoholism
• Hepatitis C
• Esophageal varices
• Family history is noncontributory

Physical Examination

• Vitals: T 102° F, BP 150/60 mm Hg, P 114 beats/min, 20 breaths/min
• Unresponsive
• Dupuytren’s contractures, spider angiomata
• 3/6 systolic murmur
• Deep tendon reflexes 3+  
• Bilateral Babinski’s sign (toes upgoing)

Which of the following are diagnostic considerations at this time? (Click on the correct answer to be directed to the second of six pages)

1. Bacterial endocarditis
2. Hypoglycemia
3. Liver failure
4. 1 and 3
5. All of the above

Cite as: Raschke RA. October 2018 critical care case of the month: a pain in the neck. Southwest J Pulm Crit Care. 2018;17(4):108-13. doi: https://doi.org/10.13175/swjpcc098-18 PDF

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