# Sub-Recommendation 6.1 Integrate data on SDOH and build a

Simon is a 58 year old patient with malignant hypertension and morbid obesity who was admitted to the ICU in an unconscious state 24-hours ago. Today he is awake, but drowsy, answering questions appropriately after delays of up to 30 seconds. Your pertinent examination data is as follows: • Patient is using suction to control all secretions. • Speech is clearly articulated with normal rate, but voice is low volume and moderately breathy. • On a general physical inspection you note left eye ptosis and miosis. • Mild overshooting is observed when the patient attempts to use his left upper extremity. • Examination of oral/facial structures and function demonstrated absent gag on left. • All facial and oral musculature is judged to be symmetrical at rest and functionally within normal limits. • There is absence of palpated laryngeal excursion on attempted dry swallows. • Laryngeal inspection (using a rigid fiberoptic laryngoscope) was significant for left true vocal fold paralysis and copious accumulated secretions throughout the hypopharyngeal cavity.

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