Betrayed Mood in Public View: Taking a MySpace History
A 19-year-old male was brought to the emergency department (ED) by the fire department after he was found wandering in the bus terminal, combative and agitated. He provided us with 2 different names and his city of origin but would not divulge any details such as family history, past medical or surgical history, current medications, social history or whether he had ingested any medications or taken any drugs prior to arrival. Among his belongings was an empty pill bottle labeled cyclobenzaprine, which had been prescribed to someone other than the name provided. He had 3 different identification cards in his possession, yet none of them had any photographs resembling him.\nOn examination, he was well-appearing, disoriented, agitated and mumbling anxiously. His heart rate was 130 beats per minute, blood pressure was 96/60 mmHg, temperature was 35.9°C (96.7°F), respiratory rate was 24 breaths per minute with an oxygen saturation of 96% on room air. His skin was flushed, warm and dry without obvious trauma or any other abnormalities. The pupils were mid-range and sluggish to light. Cardiac examination revealed tachycardia without murmurs, and the lung examination was clear to auscultation bilaterally. He had no abdominal tenderness. He displayed no focal neurologic deficits and moved all extremities spontaneously with 5/5 strength. Reflexes were +2/4 bilaterally. He was disoriented to place and time and after persistent requests to state his name, he gave the same name consistently as time progressed.\nA chest radiograph showed clear lung fields, and an ECG showed sinus tachycardia without QRS widening or QT prolongation. The patient became increasingly anxious, attempting to leave the room and becoming more hostile with medical personnel even after multiple trials of reorientation, reassurance and calming techniques. He would not provide us with any family contacts for further information. He was restrained for his own safety. A basic metabolic panel, a complete blood count, acetaminophen and aspirin levels, and a urine drug screen were ordered.\nAs we were unable to determine his true identity, we used the names he had given us to search the Internet. Upon entering one of the names on , an account that displayed a picture of our patient appeared. Positive identity was made after reviewing several photographs while matching his hometown to what was included as “location” on his profile. On his public profile, 3 days prior to presentation, he stated that he was “chillin in [a] motel room,” and his mood was “betrayed.” This enabled us to determine that he might have suffered a life stressor recently that eventually led to his visit to the ED that night.