A middle-aged female is brought in by EMS yelling and thrashing on a stretcher. Per report, she was found unresponsive next to the couch by her daughter. She was given 2mg of IM Narcan and woke up a bit and has been agitated ever since. You just begin your assessment and order some labs before you are pulled away to two Level I traumas and an impending respiratory arrest. As you head back to the patient's room to complete your assessment, you receive a "critical value" phone call from the chemistry lab. You are told that your patient has a troponin of 0.65.
After thinking to yourself, "Oh S--- I
didn't expect that, not even 100% sure why I ordered it", you realize
that you have not yet seen the EKG. It's not in the chart, so you hurry
to her room to find a nurse and security wrestling with half-naked
agitated patient who is trying to stand up on the stretcher and grab on
to the light fixture above. You call your attending and he agrees "that
THIS" (turning to the wrestling match) "is not going to work."
You decide to intubate her to facilitate your greatly expanded workup
for altered mental status. Post intubation, you get this EKG:
Read the case conclusion here.