گروه طب اورژانس دانشگاه علوم پزشکی مشهد

According to the records of the local general hospital, the patient
had an impending respiratory arrest and comatose mental status. Her
blood pressure was 71/48 mmHg, her body temperature was 36.0℃, and her
pulse rate was 99 beats/min with a sinus rhythm by electrocardiography
(ECG). Neurologic examination revealed pinpoint pupils and a lack of
brain stem reflexes, including the light reflex, corneal reflex, gag
reflex, and doll's-eye phenomenon. She also showed decerebrated
rigidity in response to painful external stimuli. The patient was
assigned a score of 5 on the Glasgow Coma Scale, and the Babinski sign
was detected at both feet. Brain computed tomography (CT) produced
unremarkable results. Endotracheal intubation was performed for
protection of the patient's airway, assisted ventilation was
initiated, and an inotropic agent was injected to support the
patient's state of shock, which did not respond to fluid therapy (1 L
of normal saline). Prior to transfer, the patient's blood pressure was
increased, but her neurologic findings were not improved. She was
transferred to our hospital for further evaluation and treatment of a
brain stem infarct.

On arrival, the patient's blood pressure was 70/40 mmHg, her pulse
rate was 59 beats/min, and an intravenous infusion of premixed
dopamine was administered (500 mL/800 mg, 20 µg/kg/min)
her self-respiration was slow and shallow. The patient's lungs on
auscultation were bilaterally clear, and cardiac examination showed a
regular rate and rhythm without murmurs, gallops, or rubs. The
patient's abdomen was soft without signs of guarding, tenderness, or
rebound tenderness. A rectal examination revealed no masses, and the
patient's stool was guaiac negative. No soiling due to urine or feces
was noted on her undergarments.

The patient's face and extremities were edematous, and she presented
with non-pitting edema
The results of the Babinski reflex test were negative.