ABSTRACT
History A woman, aged 78 years, was found by her daughter at home on the floor, apparently unconscious. She was admitted to hospital by ambulance. In A&E, she appeared disorientated and apathetic. Her skin appeared pale and her pulse was 65 beats per minute, blood pressure (BP) 125/65 mmHg and respiratory rate 17 per minute. Her rectal temperature was 34.3°C, but she was not obviously shivering. On general examination, there was no evidence of trauma, her chest was clear and there were no neurological localizing signs, although her reflexes appeared rather slow. Electrocardiogram (ECG) showed a bradycardia with low amplitude.
