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JAMA Clinical Challenge
May 3, 2016

An Elderly Unresponsive Patient

Author Affiliations
  • 1Section of Cardiology, University of Tennessee School of Medicine, Memphis
  • 2Veterans Affairs Medical Center, Memphis, Tennessee
  • 3Jackson Clinic, University of Tennessee, Jackson
JAMA. 2016;315(17):1896-1897. doi:10.1001/jama.2016.4462

A 79-year-old man with a history of hypertension, stroke, and glaucoma was brought to the emergency department after being found unresponsive by a caregiver. He was cold to the touch; blood pressure was 85/55 mm Hg, heart rate was 36/min, respiratory rate was 14/min, and pulse oximetry was 100% on ambient air. Multiple temperature measurements, including a core temperature assessment via the rectal method, did not yield a detectable temperature. His chest examination was clear to bilateral auscultation. Chest radiographs and computed tomography of the head were negative for any acute pathology. Routine laboratory tests were ordered, and he was started on an intravenous fluid. His electrocardiogram (ECG) on presentation is shown in Figure 1.

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