Altered Mental Status 273260.An unconscious 51-year-old woman is brought to the ED by EMS.
A friend states that the patient was complaining of feeling weak. She vomited
and subsequently “blacked out” in the ambulance. The friend states that the
patient has no medical problems and takes no medications. She also states that
the patient smokes cigarettes and uses cocaine, and that they were snorting
cocaine together prior to her blacking out. The patient’s BP is 195/80 mm Hg,
HR is 50 beats per minute, temperature is 98.6°F, and RR is 7 breaths per
minute. What is the eponym associated with her vital signs?
a. Cushing syndrome
b. Cushing reflex
c. Cullen sign
d. Charcot triad
e. Chvostek sign
261.A 47-year-old man is brought to the ED by EMS after being persistently
agitated at a business meeting. The patient’s coworkers state that he has been
working nonstop for a day-and-a-half and that he always seemed like a healthy
guy who frequented bars every night. EMS administered 25 g of dextrose and
thiamine with no symptom improvement. In the ED, the patient is anxious,
confused, tremulous, and diaphoretic. He denies any medical problems, med-
ications, or drug ingestions. His BP is 182/92 mm Hg, HR is 139 beats per
minute, temperature is 100.4°F, RR is 18 breaths per minute, and fingerstick
glucose is 103 mg/dL. An ECG reveals sinus tachycardia. Which of the follow-
ing is the next best step?
a. Administer acetaminophen
b. Administer folate
c. Administer diazepam
d. Recheck fingerstick glucose
e. Administer labetalol