14th August 2024

You are asked to review a patient on the ward urgently who has lost consciousness

You are asked to review a patient on the ward urgently who has lost consciousness. The patient is a 75-year-old man who was admitted with a CURB-65 score 3 pneumonia, which is being treated with IV co-amoxiclav and oral clarithromycin. His medical history is significant for chronic ankle pain following a fracture and attempted reconstruction, for which he takes amitriptyline, and anxiety, for which he takes sertraline.

The morning ward round entry records him as being significantly improved compared to admission, and he had been weaned off oxygen onto room air.

On examination, he appears pale. The airway is patent with no added sounds. There are left basal crackles consistent with the morning’s examination findings. His peripheries are cool, but a rapid central pulse is palpable. He is unresponsive. Pupils are equal and reactive to light, and there are no abnormal eye movements. Systemic examination does not reveal any abnormality.

Which is the single most appropriate next investigation to guide management?

Select the SINGLE most appropriate option from the list below. Select ONE option only.