EMS is called to a local restaurant on a very hot day for a 17 year old male patient who experienced a syncopal episode.
On arrival the patient meets the ambulance in the parking lot and says, "Hey, man, I'm really sorry. We don't need the ambulance."
Paramedics asks what happened and he says, "I just sort of… you know… took a hard swallow of Mellow Yellow… I guess…. and…. like…. I don't know if it went down wrong…. or whatever…. but like…. I sort of passed out…. but it's cool now."
The paramedics confirm that the patient is only 17 years old and inquire as to whether or not a parent or guardian is present. The patient's mother steps up and paramedics persuade her to allow them to "check her son out" in the back of the ambulance to "make sure everything is okay" on the condition that they don't receive a bill.
The patient also consents.
In the back of the ambulance the patient states that he is perfectly healthy. The only medical history is acne for which he takes a prescription medication but he forgets the name.
He appears well. The skin is pink, warm and dry.
He states that he has been drinking lots of fluids and making lots of urine.
(In response to one of the comments: he was specifically asked about his fluid status because the weather was hot and humid and EMS had been responding to many heat-related emergencies. This was not intended to convey in any way that the patient is an undiagnosed diabetic).
Both the patient and the mother deny any family history of syncope, seizures, or unexplained sudden deaths.
Vital signs are assessed.
- RR: 16
- Pulse: 90
- BP: 127/84
- SpO2: 100 on RA
Breath sounds clear bilaterally.
Neuro exam normal.
(Update: The BLG was 108.)
The cardiac monitor is attached.
A 12-lead ECG is captured.
The patient says, "So, am I going to live?"
What are your thoughts?