Case Presentations of the Harvard Emergency Medicine Residencies

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Todd A. Jaffe MDN. Stuart Harris MD, MFAKathleen Wittels MD and Susan R. Wilcox MD

Journal of Emergency Medicine, Copyright © 2020 Elsevier Inc.

Dr. Todd Jaffe: This is the case of a 49-year-old man who presented to the Emergency Department (ED) with unresponsiveness. The patient had a history of hyperlipidemia on rosuvastatin 40 mg daily but was healthy prior to the day of presentation. Per the patient’s son, the patient had two glasses of wine with dinner the previous night and was otherwise in his usual state of health prior to going to sleep. He was last seen well at 8:00 pm . The following day, his son heard a loud thud from his father’s bedroom at 12:45 pm . He entered the room to find his father on the floor, unable to move, and he immediately called 911. On Emergency Medical Services (EMS) arrival to the scene, they found the patient on the floor intermittently blinking, but not moving his extremities. Finger stick blood glucose was 107 mg/dL. EMS placed a cervical collar at the scene and transported the patient to the hospital. A 12-lead electrocardiogram (ECG) obtained in the ambulance demonstrated a sinus rhythm at a rate of 92 beats/min with evidence of a right bundle branch block, 3-mm ST depressions in leads V4–V6, and 5-mm T-wave inversions in leads V1 and V2 ( Figure 1 ).

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