Author: Yukiko Kubota-Sjogren / Editor: Steve Corry-Bass / Codes: PhC5, PhP3, SLO3 / Published: 19/02/2022

A 62-year-old lady is brought in by ambulance after being found slumped on the bedroom floor acutely confused and agitated. There was evidence of several vomitus around her bedroom and she is unable to stand.

Your initial assessment is as follows:
A – Making snoring sounds but not tolerating adjuncts
B – RR 20, chest clear
C – HR 82, BP 157/102, Heart sounds normal, warm and well perfused
D – Pupils equal and reacting to light, GCS 10/15 (E4 V2 M4)
E – Soft abdomen and calves, redness to R hip. Temperature of 37.2.

She was last seen behaving normally the night before, only complaining of some abdominal pain and an episode of vomit. She is known to drink alcohol to excess on a background of hypertension and reflux, but has not consumed much of this in the preceding days. She had been feeling generally unwell for about a week prior to presentation.

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