A 79 year old male with a history of hypertension and chronic kidney disease presented to the Emergency Department complaining of right hip pain after falling in his home. He reported that he tripped over something and that there was no preceding chest pain, palpitations, or syncope. Emergency room evaluation revealed a right femoral neck fracture and he was admitted for further care.
The following day, the patient underwent bipolar replacement of the hip and was sent to the recovery room in good condition. Several hours after surgery, nursing staff discovered that the patient was in respiratory distress and had mental status changes which progressed to unresponsiveness. Narcan was given without apparent response. He was intubated and transferred to the ICU.
Over the next several days the patient’s condition continued to worsen. Chest x-ray showed persistent bibasilar patchy infiltrates. Vasopressors were started due to hypotension and decreased urine output. The patient began decerebrate posturing on his neurologic exam and CT scan of the brain revealed extensive areas of abnormal low attenuation in the periventricular white matter areas. Red blood cell transfusions were required due to anemia and total parenteral nutrition was added due to his persistent comatose state. Eight days postoperatively the patient failed to show any improvement and the family decided to withdraw life support. The patient remained comatose after extubation and died two days later.