Kari Blaho, MD

A 41-year-old man complaining of left-sided chest pain for 2 hours was examined in the emergency department (ED). On arrival, his blood pressure was 160/100 mm Hg; heart rate, 90 beats per minute; respiratory rate, 18 breaths per minute; oxygen saturation, 99%; and temperature, 37.2°C (99°F).

Police brought a delirious, combative 24-year-old man to the emergency department. The patient was unable to provide any history on arrival, but his scarred, blistering lips and his vital signs (blood pressure, 166/102 mm Hg; heart rate, 97 beats per minute; respiratory rate, 24 breaths per minute; and temperature, 38.2°C, or 100.9°F) led to a possible diagnosis of cocaine-induced delirium.