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A 24 yo male is brought in to our emergency department by EMS. The patient was caught stealing by a security officer at a grocery store. The patient was found by EMS intoxicated, yet awake, alert and verbal, with self inflicted slash marks to his right wrist (apparently done by the patient after he was apprehended). There were no other signs of trauma. His vital signs were as follows: 122/64, 114, 16. Pressure dressings were placed on the minimally bleeding right wrist wound and the patient was transferred without incident to our ED.
On arrival, the patient was noted to have sonorous respirations and was sleepy but arousable. We had no medical or social history and the patient was unable to provide us with any information. His VS on arrival were as follows: 112/52, 120, 12, 97% on RA, Oral temp 100.3, FSG 136. PE, as follows: HEENT: AT/NC, Pupils 7mm (reactive), dry oral mucosa without lesions. Neck supple. Cardio pulmonary exam- prominent upper airway sounds. Abd.: soft/NT/ND with hypoactive bowel sounds. Extremities: partial thickness laceration to volar surface of the right wrist. No active bleeding. Neurovasc. intact. Neuro: Stuporous, arousable to noxious stimuli, moves all extremities but unable to follow commands. GCS=10.
Intravenous access is established, blood work is sent for chemistry, LFT’s, CBC, coagulation profile and serum and urine tox screens. A brain CT was also ordered due to the patients mental status, intoxication and possibility of unwitnessed head injury. He was placed on a monitor and an EKG was done (shown below). While awaiting the CT, the patient had a witnessed, self-limited 30 second generalized tonic-clonic seizure. The basic lab work (CBC, coags, SMA-20) came back unremarkable. The serum and urine tox screen is pending.
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What is the differential diagnosis at this point?
Does the physical exam help us in any way?
Does the EKG help us in any way?
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