On arrival, the patient was diaphoretic, alternately
somnolent and agitated, and unable to follow commands. No seizure
activity was noted. Her eyes opened spontaneously. She spoke but
produced only incomprehensible sounds. She withdrew inconsistently from
painful stimuli. As far as could be ascertained, she had been well
previously and had been taking no medications.
The temperature was
35.5°C, the blood pressure was 120/76 mm Hg, the heart rate was 108
beats per minute, the respiratory rate was 36 breaths per minute, and
oxygen saturation was 100 percent while the patient was breathing room
air.
Physical examination revealed no evidence of traumatic injury.
The pupils were 5 mm in diameter, round, and reactive to light. The
gaze appeared intermittently disconjugate. There were no neck masses;
palpation of the neck did not appear to be painful, and the neck was
fully mobile with no apparent stiffness or limited range of motion. The
lungs were clear on auscultation. The heart rate and rhythm were
regular, and there were no murmurs. The abdomen was soft, nondistended,
and without palpable masses. The extremities were warm and well
perfused, and the patient moved them all equally well. She was
incontinent of stool, which was brown and negative for occult blood.