Head and neck exam, are unremarkable other than for bad dentition and odors. The patient is unconscious. Pupillary response to light is normal and fundi are unremarkable. Exam of the chest and abdomen are unremarkable, other than the presence of bibasilar crackles in both lung fields, and a palpable spleen tip. Extremity exam reveals a lot of caked-on dirt, bruises and scratches but no other abnormalities.
Neurologic exam reveals no abnormal reflexes and diffuse flaccidity.
Rectal exam is normal with a small amount of stool noted in the ampulla that tested negative for occult blood. The end of the endotracheal tube is just above the carina, lung fields are clear. Heart size is normal. You are sure that he is much more intoxicated. You immediately request a freezing point osmolality.