Two days later the patient returned from his farm to visit his physician again. At this time, he complained of nausea and vomiting and was tremulous and appeared to be tachycardic. His physical exam found him to still be wheezing, although it was slightly better. His abdomen was found to be only mildly tender without any rebound. He had normal active bowel sounds. He was tremulous on exam and his pulse was 128 with a blood pressure of 140/94 mm Hg.