EN ROUTE: It is 30 minutes pаst yоur end оf duty fоllowing а slow 12 hour shift when dispаtched to a local residence for an unresponsive patient. Response time is approximately 5 minutes, and the scene is 20 minutes to the nearest level 1 hospital. Dispatch gives the patient weight as over 500 pounds. ON SCENE Upon entering the residence, the family brings you to the patient who appears unresponsive on the couch. They are responsive to deep pain, breathing slightly rapidly, and have no visible airway obstruction. Pulses are thready and they have cold, diaphoretic skin. Family reports that the patient is a 55-year-old who has been complaining of palpitations despite no recent physical exertion or activity. The following ECG was captured, along with these vitals: HR 190, RR 24 with clear lung sounds bilaterally, SpO2 94%. The fire department arrived with 2 EMTs. The family reports that the patient is a type II diabetic with hypertension, but otherwise has no cardiac history. POST SCENE Patient converted on scene with HR decreasing to 100bpm. With assistance from the FD, the patient was transferred to stretcher, moved to the unit and loaded for transport. You have one of the firefighters come with you to the hospital because patient is responsive but confused. 5 min into transport, the patient goes unresponsive and returned to HR of 190.