Friday, 19 November 2010

63 year old male CC: Syncope

EMS is called to the home of a 63 year old male who has experienced a syncopal episode.

On arrival the patient is found sitting in a dining room chair that his spouse brought to the foyer. A grocery bag is up-ended with groceries all over the floor.

The patient has vomited but he does not appear to be incontinent of urine.

He appears to be acutely ill.

The patient is awake and oriented to person, place, and time but not event.

Skin is cool, pale, and diaphoretic.

The patient's baseline SpO2 is 96. He is placed on oxygen via NRB mask @ 15 LPM.

He denies chest discomfort, palpitations, or shortness of breath.

Past medical history is significant for hypertension and congestive heart failure.

Medications include aspirin, spironolactone, and carvedilol.

Vital signs are assessed.

RR: 20
HR: 64 R
BP: 102/58

The cardiac monitor is attached.

A 12-lead ECG is captured.

What's next?