You are just started your night shift 😢 , a 23-year-old lady with no significant past medical history was brought to the emergency department after being found unresponsive at home. Her family found medication strips of paracetamol and diclofenac beside her.
Her initial vital signs at presentation were as follows: pulse rate of 95 beats per minutes, regular; blood pressure is 109/83 mmHg; respiratory rate 25 breaths per minute and temperature of 370 c.
Her initial physical exam was unremarkable apart from low Glasgow coma scale of 7/15 with normal size reactive pupils. Due to her CNS depression, she was intubated and mechanically ventilated.
Initial ECG at presentation
Few hours later she went into multiple episodes of ventricular fibrillation refractory to the ACLS.