“Raving” altered mental status

Scenario overview You are working in a community ER in the southwest when the volunteer EMS unit brings a man in his 20s from a campsite. The patient and his friends are on their way to “Burning Man” festival and stopped at the local campsite for a few days. They have been doing drugs (marijuana and MDMA [ecstasy]) and drinking. The patient was “tripping” and was climbing among the boulders and crevasses near the camp site and was gone for some time. After coming back to the bonfire and campsite, the patient started to complain of leg cramping and “twitching.” Initially, his friends thought he was joking around but the pain increased over the next hour or so until he collapsed and “was like spasming, man” EMS volunteer crew says he is arching his back and having strange movements but is talking to us and screaming in pain.