This is an interesting case, something a bit on the unusual side even.
Here is the known history, actually it’s a pretty complete history, very straightforward.
Complaint; 37 year old male with a syncope.
History of Present Illness; One week of “sore throat” with “neck sniffness”. He was drinking tea with his wife when he felt light headed. She helped him to the bathroom where he lost consciousness and she called 9-1-1. Fire department first responders found him conscious, with a small head laceration.
ALS and BLS crews arrive simultaneously and find the patient sitting in a dining room chair.
Medications; OTC for his minor illness.
Allergies; Seasonal only.
PE; Conscious, alert, oriented x 3, skin cool, pale, non diaphoretic. No dyspnea, breath sounds clear, BP 124/72, HR 72, RR 20.
Before ECG leads are applied, the patient complains of feeling faint, loses radial pulses, has a syncopal episode. He is placed on the floor and rapidly regains consciousness. BP is now 118/P, HR unchanged.
EKG leads are applied, EKG shows sinus rhythm at 68. Blood Glucose is 138. O2 saturation is 100% on Oxygen 4L via nasal cannula. IV of warmed Normal Saline started, 250 ml bolus infused.
This is the 12 Lead ECG obtained. Serial 12 Leads were done, but all were the same as this.
Patient remains unchanged during transport.
What’s going on with this patient?
Please answer in the comments. I’ll provide the answer in a few days. I have no doubt that a couple of my frequent EMS readers will figure it out. I’ll probably hold any comments of anyone who does get it a few days to give everyone a chance to look at it.