An Unresponsive 45-Year-Old Woman Foaming at the Mouth

Gregory Taylor, DO; Jacklyn McParlane, DO

Disclosures

September 20, 2018

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

Background

A 45-year-old woman is presented to the emergency department (ED) as priority 1 unresponsive. Her boyfriend told an EMS worker that they had had an argument in the early morning, after which he left for work. When he arrived home 12 hours later, he found her lying on the bedroom floor, foaming at the mouth and unresponsive. She had been in that state for an undetermined amount of time.

CPR was initiated on site. Upon EMS arrival, the patient was noted to have agonal breathing. Her Glasgow Coma Score (GCS) was 3. Her respiratory rate was 4 breaths/min, heart rate was 76 beats/min, and blood pressure was 76/42 mm Hg. She was given 2 mg naloxone and showed improvement in respiratory rate (16 breaths/min); however, she did not demonstrate a change in mental status. She was subsequently intubated. The rest of the patient's history was initially limited secondary to her unresponsive state.

Comments

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