Q a a r. Pooja Agrawal: Today’s case is that of a 64-year-old oman who was brought in to the Emergency Department y Emergency Medical Services after an apparent suiide attempt. The patient was upset that her husband was till communicating with his ex-wife, who lived in their uilding. After being involved in a verbal altercation ith this woman, the patient stated that she wanted to ie, and subsequently ingested a handful of pills. After uestioning, it was determined that she had taken over 40 ills of 50 mg nortriptylene 2 h before presenting to the mergency Department. She denied ingesting anything lse. She was, at this point, asymptomatic. The past medical history was significant for depresion, hypertension, type 2 diabetes, and mild chronic bstructive pulmonary disease. She had no personal hisory of syncope or coronary disease. The family history as non-contributory; there was no history of sudden nexplained death. Medications included aspirin, chloriazepoxide, hydrochlorthiazide, lisinopril, metformin, someprazole, nortriptyline, tramadol, and simvastatin. here were no recent fevers, illnesses, or trauma. Vital signs were: temperature 36.4°C (97.5°F), heart ate 95 beats/min, blood pressure 160/72 mm Hg, respiatory rate 16 breaths/min, and oxygen saturation 95% on oom air. Initially, the patient appeared agitated and onfused, and subsequently became more somnolent ith shallow breathing. Physical examination revealed o evidence of head injury. Pupils were equal, round, and eactive to light. The neck was supple without meningeal igns. Heart sounds were rapid and regular with no urmurs, rubs, or gallops. The lungs were clear bilaterally o auscultation. The abdomen was soft, with no distenion, tenderness, or guarding. Extremities were warm and ry without rash or swelling. There were no track marks. a