Vital signs on arrival at our facility: BP, 80/50 mm Hg; heart rate, 114 beats/min; respiratory rate, 37 breaths/min; oxygen saturation, 90% on mechanical ventilation. He was somnolent, but responsive to voice. Assessment of head, eyes, ears, neck, and throat: eyelid edema bilaterally; neck supple, with no lymphadenopathy or jugular venous distention. Cardiac: palpable precordial heave, rapid but regular rhythm, and no murmurs, rubs, or gallop. Chest: bilateral crackles without wheezes. Abdomen: mildly distended but nontender to palpation, with spleen palpable 2 cm below the costal margin. Extremities: trace pedal edema, unremarkable skin.