b'PACEP SCIENTIFIC ASSEMBLY 2024 CPC REVIEWWhat is the Diagnosis?A special thank you to Alexandra Amaducci, DO, FACEP for organizing the CPC competition during Scientific Assembly, to Jenna Lynch, MD from University of Pittsburgh Medical Center for submitting the case and being the resident presenter, and John Pester, MD from St. Lukes University Health Network for being the attending discussant.CPC CASE Syncope & Encephalopathy 44-year-old femaleSTUDY presented to the ER after a syncopal episode, seizure-like activity and loss of consciousness THE CASE Regained consciousness after EMS arrived Labs: Complained of chest pain EKG showed ischemic changes with t wave inversions and Na: 132 ST depressions in leads V4-V6 K: 3.8Patient was encephalopathic, mumbling words and pullingCl: 99at lines/tubes Co2: 9 Unable to obtain manual or cuff BP AG: 29BUN: 3PMhx: hypertension, depression Cr: 0.2Meds: amlodipine, sertraline Glucose: 43NKDA Hb: unable to obtainSocial history: unknown Hct: 15VS: HR 75 bpm, RR 20 bpm, SpO2 98% RA PE: General: encephalopathic, pulling at wires and linesHEENT: pupils 3mm and symmetric, mmmPulm: patent airway, breath sounds clear and equal bilaterallyHeart: RRR, no m/r/g, no palpable radial pulses Abd: soft, nd, TTP epigastric regionExtremities: no deformities, bruising or rashes; somewhat cool extremitiesNeuro: confused, mumbling, incomplete sentences, movingall extremities What test will make the diagnosis?What is the final diagnosis?see conclusion on page 25PACEP News | Summer 2024 21'