EKG of the Week – Week 24

 This EKG comes from a 65 year old female with a chief complaint of altered mental status.  She was found down at home and EMS tell you that her HR for them was 20.  You decide to run her in the trauma 2 with an intern, a second year and you running the case.  What do you want the intern to do?  What should the second year do?

Initial vitals: HR 22, BP 60/palp, RR 18, Pulse Ox 90% on RA, Temp 102F, D-Stick 531

Here is her EKG:

What are your concerns?  Let’s say her GCS is roughly a 7.  What do you want to do?  Are there any medications you want to give?  Procedures to set up for?  Can you immediately go to intubate someone with a BP of 60/palp?  I guess technically you can, but should you?  Any interventions you want to take first?  Should you pace her?  how?  Any consultants you want to call? Is it too soon?
Thought about those questions?  here’s some labs for you:
VBG: pH of 7.15, CO2 20 O2 45 HCO3 10 Lactate 4iSTAT chemistries unremarkable, K was 4 ish.
 This was a really cool case that turned out really well.  Think hard about this one!