Loss of Consciousness: Your Dx?

October 13, 2014

A 50-year-old man comes to the ED after 2 episodes of loss of consciousness and vomiting. Jaw clenching with a short period of unresponsiveness is observed in the ED. ECG is significant for bradycardia and sinus bradycardia. He had sprayed his home for termites 10 hours earlier. What is the problem here?

A 50-year-old man presented to the ED after experiencing 2 episodes of loss of consciousness. On the way to the ED, he became nauseated and vomited. In the ED, he was observed to clench his jaw with unresponsiveness for less than 1 minute. His vital signs were significant for bradycardia and sinus bradycardia. His ECG is shown here. The patient reported that he had sprayed the exterior of his house for termites approximately 10 hours earlier and had lost consciousness for 10 minutes about 7 hours later.

What is the problem here?