EMS is called to the residence of a 58 year old male patient who was found unconscious at the bottom of the stairs by the spouse.
The patient responds to painful stimuli with a grimace.
Respirations are shallow.
Past medical history: MI, pacemaker/ICD, renal insufficiency
Medications: Numerous – unable to locate at the time of evaluation
Radial pulses are absent.
The cardiac monitor is attached and shows strange, slow waves.
By the appearance of the ECG paramedics are surprised that the patient is not in cardiac arrest.
They prepare the patient for immediate transcutaneous pacing (TCP).
Paramedics report capture at 60 PPM and 80 mA.
The patient regains consciousness but is not alert.
He is not conversant but nods his head to simple questions and manages to mouth the word, “Sick.”
What do you think is wrong with this patient?
What do you think about the current course of treatment?