Here’s a wonderful case submitted by a faithful reader who wishes to remain anonymous.
EMS is called to perform a “health and welfare” check on a year old 68 year old female who has not been seen by the neighbors for at least 24 hours.
After several phone calls to the residence from dispatch and a discussion with the patient’s daughter, the fire department gains entry through a window in the back of the house.
The patient is found lying supine on the kitchen floor.
She is unresponsive with dried vomitus around the mouth.
Vital signs are assessed.
RR: 8 and shallow
Pulse: 46 and irregular
The cardiac monitor is attached.
SpO2: Initially does not register
Airway reflexes are absent.
The patient is intubated.
SpO2: 100 with oxygen via BVM
ETCO2: 20 mmHg
An IV is established.
1 mg atropine and 2 mg naloxone are given with no effect.
Skin is pale and cold to the touch.
Physical exam reveals no head trauma.
A 12-lead ECG is captured.
You are 10 minutes from the local non-PCI hospital and 45 minutes from a STEMI Receiving Center.
What do you think is going on here?