Alan Parker is a 52 year old man brought in by ambulance to your metropolitan Emergency Department unconscious. His employee found him in his bed at 11am and was unable to rouse him so called an ambulance.
He was last seen well the previous day and had not mentioned any symptoms at this time.
He had a past medical history of hypertension, migraines and anxiety depression.
He current medications are unknown.
He lives alone but his employee stated he is usually independent for all activities of daily living, doesn’t smoke and drinks occasionally.
On examination you find:
Eyes remain closed to painful stimuli
Localises to a painful stimulus with both arms
Incomprehensible sounds to painful stimulus
His pupils are small but reactive
He has a corneal reflex, and normal oculocephalic (doll’s eye) and has a gag and cough reflex
No apparent neck stiffness
He is breathing spontaneously at a rate of 14 and normal breathing pattern. Sats 97% 3L nasal prong oxygen
His HR is 120 and ECG shows sinus tachycardia with normal QTc and QRS duration
NIBP 140/80
Temp 36.8 degrees
He has no track marks
Can you give a few differential diagnoses for his presentation?
Name TWO interventions you could try in ED that may immediately reverse his coma