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The clinical approach to coma.

Few historical clues were available, requiring careful analysis of the vital signs and clinical findings. On presentation, glucose level was normal. The pulse was 102 beats/min with a normal electrocardiogram, and blood pressure was 154/90 mmHg, neither too low nor too high. The temperature was 36.11C, consistent with a mental status of depression. The patient was tachypneic with a respiratory rate of 20 breaths/minute. The respiratory rate is the most subtle and revealing of all vital signs. The pattern and depth of breathing can help distinguish a toxic metabolic lesion from a structural cause of coma. How deeply did he breath? Was his breathing characteristic of any disorder? The respiratory rate subsequently declined, leading to mechanical ventilation.