Slower every week

An 81-year-old is brought in barely rousable in January; her daughter says she has been 'winding down' for a month.

81-year-old womanED, resus bay 1Fictitious educational patient

Lives alone, medications 'sorted her own way'Atrial fibrillation, previously on amiodaroneRemote thyroid surgery, scar noted

Day 0 · 09:50

Arrival

A month of slowing: sleeping most of the day, eating little, cold in a heated flat, hoarse when she speaks at all. Today she would not wake. There is an old transverse neck scar nobody can explain and an amiodarone box, empty, dated last year.

Vitals

HR44BP92/60RR9SpO291%T34.6

Examination

Neuro: GCS 11; profoundly slow to respond; reflexes present with strikingly delayed relaxation.
General: Cool, dry, doughy skin; periorbital puffiness; macroglossia; thin lateral eyebrows.
Cardiac: Bradycardic, sounds quiet.

Hypothermia, bradycardia, hypoventilation, and stupor in an elderly woman in winter. What pattern should already be forming?

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